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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br /> Water supply dispenser with <br /> Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature Date <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Propane Tank <br />-i <br />Bleach and Water <br />Fire Extinguisher <br />L <br />Soap and Water <br />z <br />Rinse Water <br />Extra <br />Water <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 />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Ice Cooler <br />Names of responsible persons to be present in booth during all hours of operation: <br />MOT A BOOTH EVENT <br />Chairman <br />Title <br />Health Permit I <br />**lmportant*A <br />I am providing the following for adequate hand washina facilities, but separate frqm utensil wash within my <br />b00th: NCTPA BOOTH sUk uuiW <br />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 />I aqr providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />P Three compartment sink. NQTA ROOTH EVENT . <br />iry cleaning of food preparation utensil <br />O 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 />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. <br />SAN JOAQUIN <br />----- COUNT Y ~ <br />, Gi'efltflf’sS jfrows <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 0 Refrigerator /H <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)—___________________________________________ <br />Garbage <br />Can <br />1868 E. Hazelton Avenue j Stockton, California 95205 | T 209 468-3420 | F 203 464-0138 I www.sjcehd com <br />n™,.1®-02 Page 8 Of 11 TEMP EVENT APP <br />Ui/Ji I f <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! f