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Environmental Health Department <br />10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br />13. <br />14.- Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Z <br />Propane Tank <br />Bleach and WaterRinse WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />I am providing the following for <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off ol the ground' <br />Stemo w/Chafling <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <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 />DateTitle <br />“Important** <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5-20 Gal <br />Hand wash Water <br />------- 209 468-3420 | F 209 464-0138 | w//w.sjgovWehdpp <br />Paqe 8 of 11 <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />lotion (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 />adequate hand washing facilities, but separate from utensil wash within my <br />1868 E. Hazelton Avenue | Stockton. California 95205JrT <br />SANJOAOUIN <br />" kiiteJ ■’ ------COUNTY------ <br />•v G'-COtness cr.--.-,5 hf'f <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 />Q Refrigerated truck O Ice bath and tubs <br /> Other (specify)—_ __ <br /> Water supply dispenser with warm water at a minimum of 1OO°F (i.e. 5-20 gallon container with spigot), <br />'^fone separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsitte persons to be present in booth during all hours 0^0Per^'°r\ <br /> ------ All food vendor booths are subject to inspection. Please make a copy’ of this‘ app'ication in <br />preparation for this event. A copy of this checklist must be in the booth at all hours o preparation and operation. Return original to fesyval coordinator three weeks pnorjo <br />this event.