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■ , f X.Environmental Health Department <br />11. <br />OR <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />**lmportant** <br />Completed by: 14. <br />Health Permit <br />PapsrHandTow«l« <br />3.BleachPropane Stove <br />-iLJ ^-^'■'2'’ <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />Pl <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra tea Bags & Food Container must bo <br />stored 6 Inches oil ol Iho groundl <br />Stomovz/Ch» fling <br />Dish <br />Extra <br />Water <br />6 Gal Hand wash <br />Wastewater Conlelnor <br />Garbage <br />Can <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br /> Refrigerated truck . <br />Toother (specify) rT <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />| Soap dispenser | <br />5-20 Gel. <br />r- Hand wash Water <br />/ <br />Rinse Water <br />I Propane Tank <br />j <br />Cutting Board <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />I r—i r ( t <br />• Soap and Water I <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVEN! <br />07/3/17 <br />.p’nl SANJOAOUIN <br />r I -----COUNTY------ <br />G'n-’fllncss j/forrs Itetc. <br />10. lam providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41°F temperature): <br /> Ice chests Refrigerator <br /> Ice bath and tubs