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Environmental Health Department <br />11. <br />OR <br />12. <br />minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of nnse/wastewater. <br />13. <br />“Important** <br />Completed by:14.Signature <br />I <br />Paper Hand T owels <br />Soap dispenser <br />Cutting Board a Bleach <br />Propane Stove <br />Propane T ank <br />Bleach and Water <br />Fire Extinguisher <br />Slerno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sanitizer bucket- <br />Dleach & waler lor <br />stonng wiping ctoths <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Waler <br />Qce Cooler <br />Title <br />0 <br />Soap and Water Rinse Water <br /> Water supply dispenser with warm water at a <br />' % SAN JOAQUIN <br />' ------COUNTY------- <br />Great ncss grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods beow <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 />Health Permit - <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bid <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 for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />L‘‘L. <br />10. <br />Contain^ rnust be ' <br />stomd 6 inches off of the ground' <br />Stockton, California95205) T1868 £• Hazelton Avenue | <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during allI hours of operation. <br />VvelXd____________ _____________c- s_ <br />All food vendor booths are subject to inspection. Please make a copy-ol.ths' aPP1'^" " <br />preparation for this event. A copy of this checklist must be m the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />Date <br />■ - 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />PaeiBom TEMhevEMT^ , .