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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Title Date <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />- <br />Propane Tank <br />Rinse Water <br />.0^Fire Extinguisher <br />Ice Cooler <br />1 <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <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 />5-20 Gal. <br />Hand wash Water <br />u <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />’ C' ■ <br />■■ %= <br />- T <br />■ / <br />10. <br />ft L <br />—/ <br />’ I <br />7 <br />r) <br />1 <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />t^-One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^^aper towels and pump-style soap container. <br />Nai\^V^r\ "ble ip^ooth during all hours of operation: <br />“Important** <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three 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 />0 Tub to store wiping cloths in bleach solution. <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. / / A.4 <br />Signature <br />=0-1 <br />.-..f-.O'-'W ... <br />I am | <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />‘Mjce chests 0 Refrigerator <br />0 Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Soap and Water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 I F 209 464-0138 I www.siaov.ora/ehd <br />06/?9/19°2 Page 8 of 11 TEMP EVENT APP <br />[^eal^emi^l