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Environmental Health Department <br />-4X. <br />10. <br />11. <br />OR <br />12. <br />Paper towels and pump-style soap container. <br />13. <br />**lmportant** <br />Completed by:14. <br />Title <br />7. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/Chafflng <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping dcths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood,ora Tarp. <br />5-20 Gal. <br />Hand wash Water <br />SANJOAOUIN <br />-----COUNTY----- <br />Ci pfuk. t i. c. <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 />( Extra \ <br />Water <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />M Three compartment sink. <br />J <br />Soap and Water Rinse Water <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 />'■gTDetergent, bleach, and wiping cloths (cleaning towels). <br />^Tub to store wiping cloths in bleach solution. <br />Date <br />Ice Cooler i <br />0 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />07/3/17 <br />• ___ ' <br />Extra Ice Bags & Feed Containers must be <br />stored 6 inches off of the ground' <br />Names of responsible persons to be,present in booth during all hours of operation: <br />p (/•' lip'/ e (x—______________________________________ <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 />pre pa ration a nd^o pe ration/fteturn original to festival coordinator three weeks prior to <br />this event. v // //w <br />z z7 y> <br />7/ ^Signature