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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14. <br />Health Permit <br />Paper Hand Tcw«l# <br />3CuttlriQ Bc'wd <br />OleadiPropane Swva <br />LL <br />Rinie W^cr Bioach e»d Water <br />Fire Excnadenar <br />Ice Cooler <br />**lmportapt*" <br />SonlUzorbudJjt- <br />t(oe;h i water for <br />storing wiping cfoths <br />Booth must be on <br />Concrote, Asphalt. <br />Plywood, ora Tarp. <br />Sterne w/Chnfflng <br />Cfsh <br />Ej®» <br />Water <br />5 Gel Herd wash <br />WnaloWF Ipr Container <br />$-20 Gel <br />HflndwMh Water <br />Prcpana lank <br />JF/ <br />SANJOAQUIN <br />J COUNTY <br />CtrctJ'It?S': y/owr. ht'ie. <br />10. 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 41T temperature)! <br /> Ice chests Refrigerator <br /> Refrigerated truck \\\V/ O Ice bath and tubs <br />Gorbago <br />Can <br />SOW dHOoittar <br />Signature ' <br /> Refrigerated truck <br />O Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. . y <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 v/lping cloths In bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />b00ttl: <br /> Water supply dispenser with warm water at a minimum of 100eF (l.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />—V ‘nchit iff Iba grunndl ■ <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_________________________________________________— <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 />Completed by: -• I <br />Title Date