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Environmental Health Department <br />10. <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 />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />14.Completed by: <br />Signature Title Date <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propone Stove Bleach <br />Propano Tank <br />Rinso Water <br />Uro f-.xlinguisher <br />Ice Cooler i <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer buckel- <br />blcach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Sierno w/Chaffing <br />Dish <br />5-20 Gal <br />Hand wash Water <br />lapi providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />Culm Ico & Food Containers must bo | <br />stored 6 Inctios oft of Um ground! | <br />■ ___________________________________________________________________________________________ <br />| Health Permit ' <br />SAN JOAQUIN <br />C O U N ■ v <br />I <br />Soap and Water <br />I am 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 ' EJ Refrigerator <br /> Refrigerated truck - |ce bath and tubs <br /> Other (specify)__________ ____________________________________________ <br />[_J 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 folldvtfng-for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <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 />this event. <br />IbLiu <br />Bleach and Waler | <br />Garbage <br />Can <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 1 F 209 464-0138 I www siqov orq/chd <br />oES26o" TEMP EVENT APP