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4 <br />Environmental Health Department <br />'ll . • J <br />KJ <br />11. <br />OR <br />12. <br />13. <br />‘“Important* <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />EHD 16-02 Page 8 of 11 <br />n <br />—I- <br />Soap and Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra <br />Water <br />Sa rut 2 er becket- <br />bleach & waler for <br />slocng wiping dolhs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Sterno w/Chatling <br />Ofch <br />Jzfwater supply dispenser with warm water at a minimum of 10CTF (i.e. 5-20 gallon container with spigot). <br />J^TOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^pfPaper towels and pump-style soap container. <br />Title <br />I <br />It . 'X. SAN JOAQUIN <br />i" I Vi':1; 7 ------COUNTY------- <br />Greatness grows here. <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 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />^H'Other (specify). <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 and operation. Return original to festival coordinator three weeks prior to <br />this event. / z? <br />Z^i/l5 r-ft <br />Exira Ice Bags 4 Food Containers must be ■ <br />stored 6 Inches off of the ground! ■ <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />JzTThree compartment sink. <br />JzfThree 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 />.0f)etergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_____Lt aS P-eAt>£.&. ________________ __________ <br />Propane Tank <br />-------------------------J <br />---------------------- <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />1868 E. Hazelton Avenue | Stockton, California 95205 [ T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />Page 8 Of 11 TEMP EVENT APP <br />■—' <br />Garbage <br />Can <br />IV.j <br />\ z. ‘I- <br />’rU.irc^' <br />10. <br />Rinse Waler