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> <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />**lmportant** <br />14. <br />Health Permit <br />Paper Hand Toweta <br />BleachPropane Stove <br />L-il'.U <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/Chamns <br />Dlah <br />Water supply dispenser with warm water at a minimum of tOOT (i.e. 5-20 gallon container with spigot). <br />£^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />Sanlttzar bucket <br />btoachA water for <br />skxfoQ wlptna cfottw <br />Booth must ba <br />Concrete. Aspi <br />Ptywwdsorai <br />SAN JOAQUIN <br />-----COUNTY <br />Cuttlno Board | <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />LJ Three compartment sink. <br />[Z 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 />SDetergent, bleach, and wiping cloths (cleaning towels). <br />S Tub to store wiping cloths in bleach solution. <br />' a^r?yl£,n0 the fo,,ow,n9 00,(1 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 />E! Io© chests Q Refrigerator <br />O Refrigerated truck Q Ice bath and tubs <br />□ Other (specify)^ <br />Names of responsible persons to be present In booth during all hours of operation: <br />rilnT ____ <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 w^k# prior to <br />Completed by. (^U^T^^VoLnj Pvlv <br />Signature Title Date <br />$-20 Gal. <br />Hand wash Water