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3/5#06-23-16;11:02AM;STOCKTON CERTIFIED FARMERS MAR <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />0 Three compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />□ Tub to store wiping cloths in bleach solution measuring lOOppm. <br />12. <br />□ Water supply dispenser with warm water at a minimum of 1 DOT (i.e. 5-20 gallon container with spigot). <br />O One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation;13. <br />••Important** <br />Completed by: 14, <br />Signature Title Date <br />1Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stave <br />JiPro pane Tank <br />Rlnso Water Bleach end Water^7 <br />Fire ExtlngulBher <br />Ice Cooler 1 <br />Pass 6 of 11 TEMP EVENT APR <br />Soap and Waler <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 />Extra Ice Bags & Food Containers must Do <br />stored 6 inches off of (ho ground! <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 />Sterna w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 ObI Hand wash <br />Wastewater Container <br />Sanitizer bucket- <br />L'eaeh & water for <br />storing wiping clothe <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-20 Gal. <br />Handwash Waler <br />Garbage <br />Can <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 />^j'lce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />EHD 16-02 <br />11/4/14 <br />Received Tine Jen. 23- 2016 10:58AM No. 0913