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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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10. <br />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 />A;□ Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Completed by: 15. <br />Title <br />Paper Hand Towels <br />Soap dcpenser <br />Cutllno Board <br />BleachPropane Stove <br />Propana Tank <br />Flro Exlhnulahera <br />stored 6 todies oft of the ground! <br />TEMP EVENT APPPaoe Hot tlBID 16-02 <br />7/M/I 5 <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 />Exira <br />Watar <br />Garbage <br />Can <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Slemo w/Chaffino <br />Dish <br />□ Refrigerator <br />,Rflce bath and tubs <br />5 Gal Hand wash <br />Waslawatsr Container <br />6-20 Gal. <br />Hand wash Water <br />Sanitizer buctat- <br />bleach & water for <br />storing wiping doBta <br />Date <br />Ice Cooler <br />Health Permit a <br />14. Names of responsible persons to be present in booth during all hours of operation: <br />"Important** <br />Extm Ice Bags t Food Conlainers must be J <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41T temperature): <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 prloLto <br />this event. <br />________ <br />Signature <br />Bleach end Wai w | <br />O 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 rlnse/wastewater. Paper towels and a pump-style soap <br />container. <br />Soap and Water Rinse Water
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