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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />{T^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />■JxJOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />Completed by:14. <br />TitleSignature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />u <br />Bleach and WalerRinse Water <br />Ice Cooler <br />TEMP EVENT APP <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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Slarno w/Chaffing <br />Dish <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Waler <br />Propane Tank <br />■■ / <br />___L <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TEMP E'.'ENI <br />07/7/17 <br />I Fire Extinguisher <br />EJ I <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[XfThree compartment sink. <br />“■“■■"■■■IExtra Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground! I <br />SAN JOAQUIN <br />----COUNTY------- <br />G r e c:.: i •? > $ arc tv s ’■, ? r ■? <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 S' Refrigerator <br />0 Refrigerated truck 0 Ice bath and tubs <br />[5K>ther (specify) 0^-6^_______________________________ _ <br />^Paper towels and pump-style soap container. <br />Names of responsible persons presenUn booth during all hours of operation: <br /> <br />‘‘Important** 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 />—MW. A J- SK722- <br />Signature Title Date