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Environmental Health Department <br /> <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 rinseAvastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />**lmportant** <br />Completed by: 14. <br />Paper l-'.ar.d Towels <br />Prcpana Stove <br />n <br />Fire Extinguisher <br />Ice Cooler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />07/3/17 <br /> <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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />® Three compartment sink. <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewaler Ccntolner <br />Garbage <br />Can <br />Sanitize.- bucKel- <br />bleachfiwalsrfar <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Sterr.o w/Chaffing <br />Dish <br />Signature <br />(3 <br />Health Permit <br />Propane Tank <br />LZ± <br />Scap and Water <br />| Bleach <br />Rinse Water <br />Culling Board | <br />SANJOAOUIN <br />------COUNTY------- <br />■ Greatness grows 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 />Ext's Ice Begs & Food Containers mist bo J <br />stored S inches off of the ground! J <br />Names of responsible persons to be present in booth during all hours of operation: <br />Nicole Moore____________________________ <br />5-20 Gal. <br />v- Hand wash Water <br />Soap dispenser | ---------- \\ h <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--------- Owner <br />Title Date <br />10.