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Environmental Health Department <br />11. <br />OR <br />12. <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 />13. <br />“Important** <br />Completed by:14. <br />Signature <br />Health Permit <br />Papei K.1- <br />Soao dispenser <br />Cutting Board <br />BleachPropane Stove <br />irin <br />Propane Tank <br />Bleach and WaterRinse Waler <br />Fire Extin gutsher <br />Ice Cooler <br />TEMPEVF.'t ••Page 8 of 11 <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a blu. <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 items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra les Bags A Food Conl»inun must bo <br />stand 6 inches olfofthe grvundf <br />Slemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastowatar Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Sanihzer bucket- <br />bleach & water lor <br />Storing wipmg cloths <br />Soap and Water <br />5-20 Gal <br />Hand wash Water <br />SANJOAOUIN <br />------COUNTY------- <br />t-*’’ Greatness grows here. <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 /> Refrigerated truck Ice bath and tubs <br /> Other (specify)__________ <br />£3 Paper towels and pump-style soap container. <br />Names of responsible persons to 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 I <br />EHD 16-02 Page 8 of 11 <br />06/18/19 <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 - <br />preparation s&d operation. Return original to festival coordinator three weeks prim <br /> <br />Tide Date <br />to <br />10. <br />Exira <br />Water