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Environmental Health Department <br />10. <br />12. <br />13.of^es^onsible^^ers^ns^b^p^esent in boolh^^kig a|l^u^^opefatio^^^ (^2- <br />“Important** <br />Completed by: 14. <br />Paper Hand Tc«»ls <br />BleschPropjna S!c\o <br />Soap and Waler Bleach end Water <br />]Fire Ext'ivjulshera <br />| Ice Cooler <br />■ <br />Health Permit H <br />Sterno w.Chairr.g <br />Dish <br />5 Gal Hand wash <br />Waste-water Cor,loner <br />Garbage <br />Can <br />Sanitizer butiwt. <br />bleach & waler (o' <br />t tenng wiping cloths <br />'JSWater supply dispenser with warm water at a minimum of 100°F (i e. 5-20 gallon container with spigot). <br />Ji^One separate tub (bucket or basin) for the collection of rmse/wastewater. <br />j^Paper towels and pump-style soao container <br />Zb Booth must bo on <br />/ Concrete, Asphalt, <br />T/srZ Plywood, or a Tarp. <br />■ <br />Title <br />5-20 Gal <br />Handwash Water <br /> <br />I <br />Soap aspenser <br />Date <br />&IT3 /CO DJJJ 4 Feed Co.stft 1S.T rrwst 40 <br />j.’c<-sd6/.->cbes cYc/lha s^.^! <br />| Prcpa.-o Tans <br />....4^7 <br />/ <br />Rmso Water <br />j_am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />OR <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />^jThree 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />L) Tub to store wiping cloths in bleach solution. <br />Cu'l.-g Board ___ _ <br />Wd <br />f ~ 1/ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 I www.sjcehd.com <br />S;78-02 Peso 8 cm TEMP EVENT APP <br />SAN JOAQUIN <br />I ; ’—COUNTY------ <br />Vix.v (jf i’oIik yrows /icir. <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 />CS^ce chests Refrigerator <br /> Refrigerated truck bath and tubs <br /> Other (specify)