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Environmental health Department <br /> <br />10. <br />utensilHjhree compartment sink. <br />12.my <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Soap and Water Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />5-20 Gal. <br />Hand wash Water <br />/ <br />Names of responsible persons to be present in booth during all hours of operation; <br />R^rMte- kkcnD —————— <br />^Important* <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 />^)-Paper towels and pump-style soap container. <br />11 • Priding the following items within my booth for the sanitary cleaning of food preparation <br />KThree compartment sink. <br />OR <br />Title Date' <br />I am | <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />Cl Ice chests ^.Refrigerator <br /> Refrigerated truck H Ice bath and tubs <br />’Ej Other (specify) ' <br />Garbage <br />Can <br />Propane Tank <br />-----------------------i <br />Stemo w/Chaffing <br />Dish <br />& san*joaouiiR <br />"J -----COUNTY----- <br />Greatness grows here. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />booth: <br />Extra Ice Bags & Food Containers must be | >. <br />1 " 1 stored 6 inches off of the ground! kj <br />ehd6« 02 Ha2eltori Avenue I stockton, California 95205 I T 209 468-3420, F 209 464-0138 | www.sjcehd.com <br />07/3/17 PageBofll 'temp EVENT APP <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 />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 />this event. 3 ~ --------- ---------- <br />Title