Laserfiche WebLink
Environmental Health Department <br />f.; <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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />SMI <br />Completed by: 14. <br />Paper Hand Towela <br />Culling Ooard <br />IPropane Slovo <br />5 LX JOL <br />Propane Tank <br />Bleach and Water <br />Fire Extlnoulshorfl <br />TEMP EVENT APPPago 8 of 11 <br />Ice Cooler <br />Exlia Ice Bogs i Food Containers must be <br />stored 6 Mies otl ol Iho groundi <br />Slornnw/Chatfing <br />Dish <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach a water for <br />tiering wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />6 Gal Hand wash <br />Waslewnlor Container <br />5-20 Gal. <br />Hand wash Waler <br />Exira <br />Water <br />Date <br />LBleach <br />Title <br />Health Permit <br />5 <br />Rinse Water <br />| Soap dispenser | <br />[z <br />Soap and Water <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />MwWWl SMI _________________ <br />-------------- <br />“Important** <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> Three jeep 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 />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 prlor_to <br />this evenCj —w1 <br />SAN JOAQUIN <br />-------COU NTY------ <br />, .■>' ( if vol IK'S $ t/l S Ill’l l . <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 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify). <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Pnnn R nf 11 • tMi tVtH IEHD 16-02 paga Boni <br />07/3/17 <br />igna