Laserfiche WebLink
Environmental Health Department/-'p1 <br />10. <br />I <br />11. <br />OR <br />12. <br />13. <br />( <br />J <br />•‘Important** <br />Completed by.14. <br />Signature <br />Health Permit i <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Bleach and WaterRinse WaterSoap and Water <br />Fire Extinguisher <br />JExtra Ice Bags 4 Food Containers mist be <br />stored 6 inchos ottol the ground! <br />Slemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />I <br />i <br />Ice Cooler $ <br />f Extra \ <br />Water <br />flWater supply dispenser with warm water at a minimum of 1 DOT (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Title <br />Garbage <br />Can <br />one for rinsing and one for a bleach <br />3® <br />5-20 Gal. <br />Y Hand wash Water <br />'Date <br />| Bleach <br />/ <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, <br />solutfbn (one tablespoon of bleach per gallon of water). <br />©Detergent, bleach, and wiping cloths (cleaning towels). <br />H^ub 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 />SAN.JOAOUIN <br />------COUNTY-------/ <br />.•op-^7 Greatness grows here. <br />l am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />';5 <l <br />i .4ac_*ir / <br />45°F (if food is used the following dayjpaintain below41°F temperature): <br />©Ice chests ^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___________________ _____ <br /> Paper towels and pump-style soap container. <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 apd operation—original to festival cQQrdaiHfQr thrift week? RnorJa <br />^hiygvent. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420| F 209 464-0138 | www.sjcehcl-COTn^ <br />EHD 16-02 Page 8 of 11 <br />07/3/17