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Environmental Health Department <br />r <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/waslewater. <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.DateTitleSignature <br />Pnpor Hand Towels <br />Culling Board <br />Propano Slova <br />I <br />Bleach and Water <br />Fire Exllngulslier <br />ice Cooler <br />TEMP EVENT APPPngol) of 11 <br />3 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Exira Ico Bags & Food Containers must be stored 6 Mies oil of the ground! <br />5 Gal Hand wash <br />Waslewaler Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8 waler tor <br />storing wiping cloths <br />Booth must bo on <br />Concrete, Asphalt,"" <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5-20 Gel. <br />HondwashWelor <br />/ Extra \ <br />Waler <br />ic7 <br />Rinse Waler <br />■’» ii <y. <br />10. <br />fl- <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 />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 />Slomo w/Chatflng <br />Dish....... <br />SAN JOAQUIN <br />’ ■' ------COUNTY------- <br />(j III fl 11) ess IJIO'A'S here. <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 />EHD 16-02 Pagan of 11 TEMP EVEN! <br />07/3/17 <br />Soap dlspanser [ ---------- - <br />SEK | <br />Ju 0 <br />- | Propane Tank <br />I ■' . . 71 <br />Health Permit I <br />rrL <br />.....- / <br />Soap and Water