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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Rinse Water Bleach and Water <br />Fire Extinguishera <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground1 <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8. water for <br />storing wiping doths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />5-20 Gal <br />Hand wash Water <br />Sig^iture <br />Ice Cooler <br />-----------------K <br />Propane Tank <br />3/WUAUUIN <br />-CO TY— <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 />preparatiomand operation Return original to festival coordinator three weeks prior to <br />this/eVeh/. 7 <br /> <br />Date <br /> Water supply dispenser with 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 />^S)Paper towels and pump-style soap container. <br />' Names of responsible persons to be present in booth during all hours of operation: <br />______________-i < A- C' t-i., <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 />' 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 41T temperature): <br />p3lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___________________________ <br />IWzdM&IL__LL <br />----- <br />Soap and Water <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 /> Tub to store wiping cloths in bleach solution <br />I am providing the following for adequate hand v/ashing facilities, but separate from utensil wash within my <br />booth: <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/11? 02 Pa9e 8 of 11 TEMP EVENT APP