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Environmental Health Department <br />10. <br />11 <br />OR <br />12. <br />supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />“Important** <br />1Completed by:14..TitleSignature <br />iiHealth Permit <br />Paper Hand Towels <br />Cutting Boanl <br />APiopane Stove <br />n <br />Propane Tank <br />Bleach and Water <br />t-'ire txtingusher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />1 <br />I <br />E«rra (ce Bags & food Confaincrs nwa t>a <br />stored f inches otto!tne grouGd1 <br />5 Gat Hand wash <br />Wastewater Container <br />5.?n nm <br />Hand wash Water <br />SaniTzer buCKet- <br />tioacn a water tor <br />storing wising ctoths <br />Sterno w/Chaffing <br />Dish <br />SAN JOAQUIN <br />COUNTY <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp <br />:__L <br />Soap and Water Rinse Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />P^A/Vater <br />'^pne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^£paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />C c 01*2-5_____________________________ __________________________ <br /> <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 <br />this event, cTx ' C <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 /> 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Garbage <br />Can <br />Soap dspenscr ' <br />I p**" K <br />3Uo <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 1 F 209 464-0138 | iwvw.sjcehdcom <br />Onnn R nf 11 I ElVIr E.VCIEHD 16-02 Page 8 or 11 <br />07/3/17 <br />to festival coordinator three weeks prior to <br />Date