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Environmental Health Department <br />11. <br />OR <br />12. <br />Q Paper towels and pump-style soap container. <br />13. <br />14.Completed by;Owner <br />Title <br />J <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />2 <br />Bleach and Water <br />FlfO Lxtinguishera <br />Ice Cooler <br />Pago 8 of 11 <br />Date <br />EHD 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 />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Cxfro /co Bags 4 Food Containers must bo <br />stored 6 Inches oil of the gmundl <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer buclret- <br />Meach 6 water (or <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Adriana Valriovinos anci/nr Brandy Salazar <br />Soap and Water <br />10. <br />LT IJ <br />Rinse Water <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 /> 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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />5-20 Gal. <br />v- Hand wash Water <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />‘‘Important** <br />Propane T ank <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 | www.sjcehd com <br />--- ------------------ TEMP EVENT APP <br />Health Permit <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Adriana Valdovinos_____________ <br />Signature <br />, \ SAN JOAQUIN <br />------COUNTY------ <br />(>real ness c/rotvs 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)