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COMPLIANCE INFO
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1600 - Food Program
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PR0541099
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COMPLIANCE INFO
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Entry Properties
Last modified
9/9/2026 11:34:54 AM
Creation date
9/9/2026 11:28:47 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0541099
PE
1695 - TEMPORARY EVENT
FACILITY_ID
FA0023534
FACILITY_NAME
INDEPENDENCE DAY CELEBRATION
STREET_NUMBER
0
STREET_NAME
CENTRAL PARK
City
MOUNTAIN HOUSE
Zip
95391
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\jcastaneda
Supplemental fields
Site Address
CENTRAL PARK MOUNTAIN HOUSE 95391
Tags
EHD - Public
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I am providing the following items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />I <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />“Important** <br />Completed by: 15. <br />DateTitleSignature <br />i <br />Paper Hand Towels <br />Culling Board 1 BleachPropane Stovo <br />Propane Tank <br />Bleach and Water <br />Fire ExlInQUlsItera <br />J <br />TEMP EVENT APPPaga 8 of 11 <br />I <br />EHD 18-02 <br />7/14/15 <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <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 />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify), <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. <br />□ Refrigerator <br />0 Ice bath and tubs <br />Extra <br />Waler <br />5 Gal Handv/ash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <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 />I <br />I <br />Slerno w/Chaffing <br />Olsh <br />! <br />Health Permit sa <br />i <br />I <br />II <br />^Ice Cooler <br />10. lam 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 4TF temperature): <br />14. Names of responsible persons to be present in booth during all hours of operation: <br />-toenPe Cd£tRo,.-NmMedelRO£, Janice-tan----------— <br />ml „ <br />72 <br />Garbage <br />Can <br />Extra Ice Bags & Food Container must be 1 <br />sloied 6 inches off of (he ground! <br />zS <br />Ahi--L Af 1 <br />§ Soap and Water Rinse Waler <br />Soap dispenser - -------- <br />it-
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