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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[J^/ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />-Important** <br />Completed by:14. <br />I <br />P»p«r Hand Towels <br />Soao dispenser <br />BleachPropane S«o»e <br />X <br />Pins* Waler <br />Fee EjdMxxasber <br />Ice Cooler <br />TEMP EVENT APP <br />Eilie <br />Waler <br />5 Gal Hand wash <br />Wastewater Conlaeter <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo wiChafTing <br />Osh <br />SANJOAQUIN <br />-----COUNTY------ <br />Crcatnea qrows here. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sohrtion (one tablespoon of bleach per gallon of water). <br />H Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />333 <br />SoapwxSWator <br />E*tr» let Btgt t Foors Cortuneri mutt bo ■ <br />tSororS 6 Inches o/T oT the ground1 d <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[7^Paper towels and pump-style soap container. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 8 oM 1 *2 <br />06/19/10 <br />| Health Permit <br />..enV-) <br />------ ' <br />Signature <br />Cuttma Board <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 /> <br />Title Date <br />' Grcotncji grows <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 Q^efrigerator <br />[TfRefrigerated truck Ice bath and tubs <br />Qdther (specify) <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />c0 Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_____________ <br />5-20 Gal <br />Hand wain Waler <br /> <br />I Propane Tank 3L <br />/ ZonKii txxket- <br />/ Weacn & water lor <br />/ f~ Hoang wiping Ootn» rfeu