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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-style soap container. <br />13. <br />“Important** <br />Completed by: 14. <br />Health Permit <br />Paper Hand Twals <br />Soap dispenser <br />BleacJiPropane Stove <br />>?■it <br />BJeactl and WalerSoap ondWntor <br />Fira Extinnuisher <br />TEMP EVENT APPPage 8 of 11 <br />£ <br />Plnco Water <br />SteinowZChalTing <br />Dish <br />Exira <br />Waler <br />b Gal Hand wash <br />WaslewatorConlofnor <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />6 20 Gal. <br />Hand wash Waler <br />Snnltiaar bucKel- <br />bloocb 6 v/ator tor <br />storing wiping cloths <br />iiZZL— <br />Ice Cooler <br />I Propone T nnk <br />preparation and operation. Return origitial to festival coordinator three weeks prior to <br />02.^25 <br />Title Date <br />Exira lea Dags S l ogd Containers must bo <br />siomd Ci Inches o/f al the ground! <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 />A-Q-l <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 />SANJOAQUIN <br />VWlWy —county— <br />Greatness (paws here. <br />10. I <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVEN1 <br />07/3/17 <br />Culling Board <br />Nan^of res^ns.ib^perso^grto^be^sen^ bo^th^diJi'hig all hours o^o^ratio^r <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 operatic “ ' ’ ' " '! <br />A Signature <br />J