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10. <br />11. <br />OR <br />12. <br />0 Paper towels and pump-style soap container. <br />13. <br />^Important <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Culling Board I <br />Soap and Wat&r Rinse Water Bleach and Waler <br />Fire Extinguisher <br />Ice Cooler <br />S Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gat Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Propane Stove <br />■ - V: <br />17 <br />Signature Title <br />Names of responsible persons to be present in booth during all hours of operation: <br />------ /t '• A. Q. Cl ■ CC [) e _____!( c; ■< >./ ee I / > <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> i hree 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 /> Ice chests Q Refrigerator <br />O Refrigerated truck v i Ice bath and tubs <br />i I Other (specify) <br />1 - <br />Date <br />Erwramenial Health Dsoartment <br />All food vendor booths are subject to inspection. Please make a copy of this apolication in <br />preparation for this event. A copy of this checklist must be in the booth at ail hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event, „ <br /> l hree 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 />O 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 washing facilities, but separate from utensil wash within my <br />booth: <br />SANJOA(WIN <br />rnn Ha2el,on Avemel Stockton, California 95205 | T 209 468-34201 F 209 464-0138 | www.sicehd.com <br />07/3/17 P39e 8 °f 11 TEMP EVENT APP <br />Soap dispenser <br />Bleach <br />i Propane Tank