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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />ature <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />Rinse WaterSoap and Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />OOtJfVfcV- <br />Title <br />Extra <br />Water <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 GaL <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <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. r . / » <br />Date <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />JZWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />3^ne separate tub (bucket or basin) for the collection of rinse/wastewater. ..' .. . ; • <br />hJ^Paper towels and pump-style soap container. <br />Prop ana Tank <br />**lmportant** <br />I am providing the following items within my booth for the sanitary Cleaning of food preparation utensil <br />L_ Three compartment sink. <br />A/fThree 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 />I^Wetergent, bleach, and wiping cloths (cleaning towels). ’ ' <br />[3 Tub to store wiping cloths in bleach solution. <br />SANJOAQUIN <br />‘ ------COUNT Y------ <br />Greotness grows 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 />\ce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Names of responsible persons to be present in booth during all hours of operation: <br />Extra Ice Bags 8. Food Containers must be HI <br />stored 6 Inches off of the ground! ) <br />Soap dispenser <br />Bleach