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Environmental Health Department <br />10. <br />11. <br />OR for soapy water, one for rinsing and one for a bleach <br />12. <br />^KT)ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />**lmpo riant** <br />Completed by:14. <br />Health Permit <br />Paper Hand Toweta <br />Soap dispenser <br />Bleact!Propane Stove <br />r <br />Propane Tar* <br />Btoacti and Water <br />Fire Extinguisher <br />TEMP EVENT! APP <br />Sterno wChaffing <br />Dish <br />5 Gat Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket- <br />bteach & water for <br />st onng wiping doths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />SANJOAOUIN <br />COUNTY <br />r-4Ice Cooler <br />I <br />Soap and Water <br />r <br />Rinse Water <br />Extra Ice Bags « Food Containers must be M <br />I stored 6 inches eft of the ground I H <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 8 of 11 TESS? EVEN? <br />07/3/17 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />P^Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br />H Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />J^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <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 /> thisevent / / n , Q <br />Title I 9 Date <br />id operation Return origin; <br />Signature <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 />O Refrigerated truck Ice bath and tubs <br /> Other (specify)—------------------ <br />^rf’aper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />SrvVrUs _ <br />CuthnQ Boart