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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-stylo soap container. <br />13. <br />“Important** <br />Completed by:14. <br />Signatun <br />Paper I land 7 ov/els <br />Soap disponsor <br />Culling Board <br />Oloach <br />Uloach and Water <br />Flro ExtinguisherG <br />Ice Cooler <br />TEMP EVENT APP <br />Health Permit <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />I-] Tub to store wiping cloths in bleach solution. <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />lXl Ice chests Refrigerator <br /> Refrigerated truck O Ice bath and tubs <br /> Other (specify)_________________________ <br />Garbage <br />Can <br />Sanillzorbuckol- <br />bleach & waler for <br />storing wiping clotlis <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Siemo w/Chafflng <br />Olsh <br />6 Gal I land wash <br />Wasiowaior Conlalnor <br />5-20 Gal. <br />Handwash Wotor <br />SAN JOAQUIN <br />COUNTY <br />Propane T enk —i <br />.|lt. . <br />Pxtoi Ico flags 4 f ood Conlalnen must bo <br />slotcd 6 inches oft of tho ground! <br />__J_ <br />Soap and Water <br />Q <br />Rinse Water <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />(£110 16.02 PnUe 0 oM 1 TEMP EVEN? <br />07/3/17 <br />10. lam providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />[ames of responsible persons to be present in booth during all hours of operation: <br />3:01 <br />| Propane Stove <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, , ) .JLA VX akOvO WATV? 1^ <2 /| ~)Ix5 <br />Title Dbte I <br />Extra <br />Water