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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Completed by: 14. <br />Signature <br />Pnpor Hand Towels <br />Soap dispenser <br />Ctillln.q Boord <br />Propane Stovo <br />A <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Slerno w/Chaning <br />Dish <br />5 (5al I land wash <br />Waslowotor Container <br />Garbage <br />Can <br />Sanitizer buckot- <br />Honch & waler tor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />---------------?}... .. ........../ • <br />Ice Cooler j <br />Title <br />SANJOAOUIN <br />------COUNTY <br />Greotncss j/rov.s herv. <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 J^pRefrlgorator <br />Q Refrigerated truck Ice bath and tubs <br />Other (specify) |(? <br />I Icalth Permit H <br />Fxlm Ico Hags S I'ood Containers must bo • <br />stored 6 Indios off of dio ground! <br />Propane Tank __I <br />|*~ Soap and Walor <br />Tiro I’xtingrilshor <br />Kinso Wnlor | Rteach nnd Wnlor <br />( Extra \ <br />Water <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />|i£prhreo compartment sink. <br /> Throe deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and ono for a bleach <br />solution (ono tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths In bleach solution. <br />0 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 />[Qjpaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />MZWH'-hM _- <br />**lmportant**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 bo In the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this CVCQt. <br />5-20 Gal. <br />I land vr.isli Water <br />Bleach s,