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Apr 26 18 12:07p B&EHospitality G o Inc 296-6432 p.2 <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />□ Paper towels and pump-style soap container. <br />13. <br />"Important** <br />Completed by:14. <br />Paper Hand Towels <br /> Soap dispenser <br />Cutting Board 3 BleachPropana Stove <br />0ItJ <br />Propane Tank <br />Bleach and Water <br />Ice Cooler ; <br />J <br />preparation for thi; <br />preparation/ar)d <br />this event/ I A, <br />Stemo wfChsfBng <br />□ish <br />Sanitizer bucket- <br />Weach & waler for <br />storing wiping cloths <br />Ex'Ja Ice Bags & Food Conlajners must be <br />stored 5 inches off ot the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra <br />Water <br />Health Permit <br />Srgnatu <br />Soap and Water Rinse Waler <br />SAN JOAQUIN <br />COUNTY <br />1868 E. Hazelton Avenue | Stockton, California 95205 | I 209 468-3420 | F 209 464-0138 | www.sjcehd.cam <br />EHO 16-02 PageSofll TEMP EVENT APP <br />07/3/17 <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 O Refrigerator <br />□ Refrigerated truck ^Ice bath and tubs <br />□ Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <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 />■Q 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 />Water supply dispenser with warm water ata 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 />Garbage <br />Can <br />I - Fire Extinguisher <br />LJI <br />Names of responsible persons to be present in booth during all hours of operation: <br />________ptfCe-U. r^.lc£>[/n_______________________ <br /> <br />AJI food vendor booths are subject to inspection. Please make a copy of this application in <br />event. A coptrof this checklist must be in the booth at all hours of <br />(pejration /IReturn xiriqinal to festival coordinator three weeks prior to <br />Title Qate <br />5-20 Gal. <br />t— Hand wash Water