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Environmental Health Department <br />G stness <br />10. <br />11. <br />OR <br />12. <br />^J/fWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />ine separate tub (bucket or basin) for the collection of rinse/wastewater. <br />'aper towels and pump-style soap container. <br />13.>onsible <br />14.Completed by: <br />Signature Title <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />JI)Rinse Waliv Bleach and Water <br />Fire Extinpuisher <br />EHD 16-02 <br />07/3/17 <br />Extra Ice Bags & Food Containers must be stored 6 inches off of the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal <br />Hand wash Water <br />SAN JOAQUIN <br />-COUNTY— <br />LrThree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />/^olu.tion (one tablespoon of bleach per gallon of water). <br />J^Tg^tergent, bleach, and wiping cloths (cleaning towels). <br />rplub 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 <br />Soap and Water <br />^Important** <br />| Health Permit <br />Ice Cooler <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 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 />^4ce chests Q Refrigerator <br />U Refrigerated truck 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 />prepar^fic is event. A copy of this checklist must be in the booth at all hours of <br />prepafati^ ration. Return original to festival coordinator three weeks prior to <br /> ““ i-—- ip/^ix~ <br />Date <br />Nan^^of re^on&ble pecs(jn^o^be.present in booth during all hours of operation: <br />1868 E. Hazelton Avenue | Stockton, California 95205 ( T 209 468-3420, F 209 464-0138 | www.sjcehd.com <br />cun ifi.no page g of 11 TEMP EVENT App <br />I r—i i C