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Environmental Health Department <br />10. <br /> Three compartment sink. <br />12. <br />13. <br />**lmportant** <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Propane Steve Bleach <br />J U u — <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler i <br />Page 8 cf11EHD 16-02 <br />07/3/17 <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />jSjDne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Stemo w/Cha/fing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8 water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tar; <br />■■■■■ I <br />5-20 Gal. <br />Hand wash Water <br />SAN JOAOUIN <br />COUNTY <br />s to be present in booth during all hours of operation: <br />i <br />Extra Ice Bags & Food Contahers must be Z <br />stored 6 inches off of the ground' <br />Health Permit J <br />_z <br />Scap and Water Rinse Water <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />OR <br />MThree 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 />Si Detergent, bleach, and wiping cloths (cleaning towels). <br />J^STub 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 an^operation/^teturn original to festival coordinator three weeks prior to <br />p7 ^Signature <br />Names of responsible persons <br />„ f*) i tJc- <br />1 axTo£r?.yLdin9 .the followin9 co,d temperature control for the cold holding of potentially hazarcious 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 />an^iproviding the following for adequate hand washing facilities, but separate from utensil wash within my <br />1863 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | vaw/.sjcehd.com <br />-2 Page 8 cf 11 TEMP EVENT APR