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1 <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />Completed by: 14. <br />Title DateSignature <br />Health Permit <br />Paper Hand Tonels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane T ank <br />Bleach and WaterRinse Water <br />Fire Extinguishera <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />ETThree compartment sink. <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 />0^Detergent, bleach, and wiping cloths (cleaning towels). <br />0Tub 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 />Eitra ice Bags S Food Containers must be <br />stored 6 inches off of the ground' <br />Extra <br />Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & vater for <br />stonng vwpng doths <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />(EfOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q'Paper towels and pump-style soap container. <br />Sterno v/Chatfing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />SAN JOAOUIN <br />------COUNT Y------ <br />Greatness grows here. <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 EfRefrigerator <br />□ Refrigerated truck O Ice bath and tubs <br />□ Other (specify)____________ <br />Soap and Water <br />‘‘Important** <br />Names of responsible persons to be present in booth during all hours of operation: <br />/A r j Ar I Cri c V_________________ <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.