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^>0 O’ qt' I <br />Environmental HeaSth Department <br />10. <br /> Three compartment sink. <br />12. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this eveat 7 ' ------------------ <br />14.Completed by: <br />Signature <br />Paper Hand Towels <br />Soao dicparscr <br />CulUeg Board <br />Propane Stove B’oach <br />■ <br />Propane Tank <br />Rinse Water Bleacti and Water <br />Fire Extinpu shcr <br />Extra tea Bags & Food Contair.ors must bo <br />stared 6 rnc/iws oft of the ground! <br />Stamo wiChaffino <br />Dish— <br />Exira <br />Watof <br />Garbage <br />Can <br />water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />separate tub (bucket or basin) for the collection of rinse/wastewater. <br />E^Paper towels and pump-style soap container. <br />5 Gol Hand wash <br />Wastewater Container <br />Sonitlror bucket­ <br />bleach & wptor for <br />storing wp!rg cloths <br />SAN JOAOUIN <br />------COUNTY------- <br />Health Permit <br />I^Water supply dispenser with warm <br />l/kDne <br />... <br />Scap and Water <br />..... <\ <br />I Ice Cooler j j <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />OR <br />^Important4* <br />5-20 Gol. <br />Herd wash Water <br />_______^//5~/ <br />Date <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 />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 />JSjce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)______________________ <br />Title <br />g) 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 />KTub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: / ■ 7 <br />Booth must be on <br />Concrete, Asphalt. <br />p»ywood. or a Tarp. <br />^8 E. nazeitDn Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjcehd.com <br />07/3/17 2 Page 8 of 11 TEMP EVENT APP