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••PC Environmental Health Department <br />10. <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 />Completed by: 14. <br />Signature Title Date <br />I <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropano Stove <br />Propano Tank <br />Bleach and Waler <br />Fira Extinguisher <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Garbage <br />Can <br />Sanitizer buckol- <br />bleach & waler for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, ora Tarp. <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 />Sterno w/ChafTmg <br />. Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 GaL <br />I land wash Water <br />Ex/rn /co Sags Food Conlainors mtisl bo <br />slorod 6 inches oil ol the ground! <br />& <br />-------------------< <br />Ice Cooler > <br />Names of responsible persons to be present in booth during all hours of operation: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | vAvw.sjcehd.com <br />El ID 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />**lmportant** 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 />11. fam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />OR <br />Soap and Water <br />Is <br />| Health Permit <br />Rinso Water <br />SANJOAQUIN <br />iw Lil I® x \ -----COUNT Y----- <br />^i/./po^/' Greotness prows 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) _