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Environmental Health Department <br />i : <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important*’ <br />Completed by14. <br />Date <br />il <br />PafHf Hand l awals <br />Propane Stove <br />0 <br />3leach and Water <br />Fire EMIngulslwra <br />Ice Cooler I <br />fl1 <br />I^A/ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewatcr. <br />Paper towels and pump-style soap container. <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 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 />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify)__ <br />Slsrnow/Chaffng <br />Dish <br />Erfra <br />water <br />5 Gal Hardwast <br />Wastewater Conta nor <br />Garbage <br />Can <br />Boolh must be nn <br />Concrete, Asphalt, <br />Plywood, or a Taip. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Jayna Casey, Bret Casey <br />5-20 Gal. <br />Hand was't Ws ter| Health Permit <br />owner <br />Title <br />■ini' (^Od. <br />Signatun <br />a4... , , ■ -r- <br />fx/ra Ico Bags S Fmd t'.onlahan trust hn <br />stored 0 ImMes ulf u! Utv yuuud! <br />I Bitsch <br />Soao dsponssr <br />I Piupana Tank L <br />Soap and Wate <br />All food vendor booths arc 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 al all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />/7 4/19//24 <br />Culling Bo«rd | <br />SAN JOAQUIN <br />COUNTY <br />Cir< «:I n<'•>5 (/i envs h< i i. <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 />□ Rofrigorator <br />□ Ice bath and tubs <br />N/a for us <br />Hz _z <br />Rhse Wale <br />/ Sanitizer bt.c<et- <br />/ bleach a water far <br />I slnrinowIpInG cloths <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 4 68-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 13-02 rage 8 ol 11 TEM= EVENT APP <br />07/3/17