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Environmental Health Department <br />10 <br />11. <br />OR <br />12 <br />[ ] Water supply dispenser with warm water at a minimum of 100cF (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 />13. <br /> <br /> <br />Completed by:14. <br />tureig. <br />Health Permit <br />IPapsr Hand T oacIs <br />Soap dispenser <br />Cutting Board A /OtoactiPropane Stove <br />u <br />Propane lank <br />2 Bleach and Water <br />Ice Cooler <br />TEM’J EVENT API’1868 I I lazolton Avenue | <br />EHD 16-02 <br />06/19/19 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <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 />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 cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day. maintain below 4 TF temperature) <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ____________________________________________ <br />l lira kc Bags 6 / ood Containers must be <br />stored 6 inches ott ot the ground' <br />E>tra <br />Wutcr <br />i Gai Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitucr bucke! <br />bicpdi & water lor <br />stonng wpng cloths <br />Storno w/Cha'tir>s <br />Disli <br />5 20 Gai <br />Hand wash Water <br />Booth must be on <br />Concrete Asphalt <br />Plywood, or a Tarp <br />SAN JOAQUIN <br />< • ‘ I. ■ <br />.,1 <br />0 <br />/ <br />Rinse Water <br />Stockton California 95205 | T 209 468 3420 | F 209 464-0138 | www sjgov ory/chd <br />Tr*nrs rtrr"»iT ttPage 8 cl 11 1 <br />"Wk <br />Date <br />|__| I ire I Ht nguisncr <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 aMvOperation. Return original to festival coordinator three weeks prior to <br />this event/^J/ A <br />-----------------— <br />nX <br />__Z <br />Soap and Water <br />Names of responsible persons to be present in bootMuring all hours of operation:^. <br />‘•Important**