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Environmental! Health Department <br />10. <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 />Names of responsible persons to be present in booth during all hours of operation: 13. <br />**lmportant** <br />14. <br />bate <br />iHealth Permit <br />Paper Hand Towels <br />Soap dlsponscr <br />Culling Board <br />BleachPropane Stove <br />JIt <br />Propane Tank <br />Fira Extinguisherfl <br />Ice Cooler <br />TEMP EVENT APP <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Exira <br />Waler <br />5 Gal I land wash <br />Wastcwator Container <br />6-20 Gal. <br />Hand wash Walor <br />Garbage <br />Can <br />Sanllizor bucket­ <br />bleach & walor for <br />storing wiping cloths <br />Stomo w/Cliatfing <br />Dish <br />Booth must bo on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />7 <br />Soap and Water Rinse Waler <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />Completed by: <br />Title Date <br />Ex/ra Ico Dags S Food Containers must bo I <br />stored 6 Inches oil of the groundl J <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD '16-02 PflQQ 8 of 11 TEJ/P UVEMl <br />07/3/17 <br />' SAN JOAQUIN <br />-!------COUNTY------- <br />|/(1OV'V'' (j/f(7lih-s$ t/rov.’S Ih:it. <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 />SZl Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify).. —_________ <br />I <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. '^7/'/ <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). 'z <br /> Tub to store wiping cloths in bleach solution. J? f if <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 />Retui <br />Signature /