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Environmental Health Department <br />i .• <br />10. <br />11. <br />OR <br />12. <br />13. <br />Date ' I <br />14.Completed by: <br />Paper Hand Tcnvels <br />Soap dispenser <br />Propane Stove <br />n <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinpulsher <br />Page 8 of 11 <br />1-0-3:« <br />Stemo w/ChaNing <br />Dish <br />5 Gal Hand wash <br />Waste*A*ater Container <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />f Extra ' <br />I Water <br />Mee Cooler <br />Health Permit <br />—" <br />“Important** <br />Garbage <br />Can <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 />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 (he following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />^Jfl/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/wastewater. <br />j^Paper towels and pump-style soap container. <br />Names .^respon^bfe^gons t^^^r^e^in booth during all hours of operation: <br />SAN.JOAOUIN <br />-----COUNTY------ <br />(j/eotm’s? ijroivs hete. <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 />'^Hee-chests Refrigerator <br /> Refrigerated (ruck Ice bath and tubs <br /> 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, zi , <br />----------y&Ls <br />'Signature J' Title <br />| Extra tea Bags i Food ConlaiMrs must be <br />J stored 6 inches off of the ground!pi i <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-34201 F 209 464-0138 I www.sjgov.org/ehd <br />Page 8 of 11 TEMP EVENT APP <br />05/19/19 <br />T I M ~7 <br />Soap and Water <br />F Cutb'np Board <br />Booth must be on <br />Concrete, Asphalt, <br />Utori P'ywood, or a Tarp. ,