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t <br />10. <br />11. <br />PrOR <br />12. <br /> Paper towels and pump-style soap container. <br />13. <br />114.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />fl <br />Bleac.h and Water <br />Fire Extinguisherfl <br />Ice Cooler <br />il 11 <br />Soap and Water <br />EHD 16-02 <br />07/3/17 <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Environ^ntal Health Department <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 v/ash Water <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 />J3lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />i' <■ <br />ature <br />Propane Tank <br />- - <br />LI _ <br />Extra Ice Bags & Food Containers must be li <br />stored 6 inches off of the ground! pJ <br />I <br />SAN-?J0*9UIN <br />------COU. .Y------ <br />7 <br />Rinse Water <br />IM <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. < <br /> Three deep tubs (basins 6-8 ingnes 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 /> Tub 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: I <br />□ Water supply dispenser with warm water a^mi^irnumof 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />**lmportant** <br />Names of responsible persons to be present in booth during all hours of operation- f <br />LLL. u r L ? <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />I - Page 3 of 11 TEMP EVENT APP <br />, __XjiAll food vendor^Dooths are subject to inspecticji. PTease make a copy of tms application ,rn <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 />—•- • A > - <br />Title