Laserfiche WebLink
SAN JOAQUIN nvir Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Propane Stove <br />I <br />Propane Tank <br />)Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />ZL <br />Scap and Water <br />z <br />Rinse Water <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 />Erba Ice Bags & Food Conlaners nrusl be <br />sloted 6 irchos oft of the ground' <br />Ext-a <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanit’zer bucket­ <br />bleach & water for <br />storing vap-ng cloths <br />Booth must be or <br />Concrete. Asphalt <br />Plywood, or a Tarj <br />5-20 Gai <br />Hand wash Water <br />Names of respgnsible persons <br />O <r;t (2 z ^7 r- <br />Sterno vXChalfing <br />0<Sh <br />C". /£ o <br />Title <br />; to be present in booth during all hours of operation: <br />___________________________ <br />‘‘Important** <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />LI Three compartment sink. <br />Jkl 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 />M Detergent, bleach, and wiping cloths (cleaning towels). <br />JS'Tub to store wiping cloths in bleach solution. <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 />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/ffieturn original to festival coordinator three weeks prior to <br />Signature <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 4(58-3420 | F 209 464-0138 | www.sjcehd com <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />A7I1M7 <br />Cutting Board -------- <br />L