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Environmentai Health Department <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 />J Paper Hand Towels <br />Soap dispenser <br />Culling Boaid <br />1.Propane Stove <br />IS® <br />Rre Extinguisbar <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Page 8 of il TEMP EVENT APP <br />Signature <br />EH0 16-02 <br />07/3/17 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/Chalfing <br />Dish <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />1 <br />Extra tee Bags e Food Containers must be <br />stored 5 tnctes oft otttie ground! <br />J <br />~7 <br />Ice Cooler <br />I Eleach <br />Propane Tank <br />Sanitizer bucket­ <br />bleach 8 water for <br />storing wiping do'.hs <br />10. <br />5-20 Gal. <br />\........... <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />K 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 />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 />--------- Owner 1/18/2029 <br />Title Date <br />5 Gal Hand wash <br />Wasle.valer Conlalner <br />SANJOAOUIN <br />------COUNTY------- <br />Greotness 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 />13 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)____ _______ ___________________________________ <br />Names of responsible persons to be present in booth during all hours of operation: <br />N icole Moore___________________________ <br />mJ-TuJ <br />c ' ,____________ <br />Bleach and Waler | <br />U II <br />Soap and Waler Rinse Waler