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Environmental Health Department <br />OR <br />12. <br />13. <br />14.Completed by: <br />ignature <br />Health Permit <br />Paper I land Towels <br />BleachPropane Stove <br />L <br />Bleach and Water <br />Fire Extinguishera <br />Ice Cooler <br />TEMP EVENT APP <br />Soap and Water <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 /> 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: <br />ti providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />Exits Ice Bags S Food Containers must bo <br />stored 6 Inches oil ol the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />bleach & water lor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />S-20 Gal. <br />Hand wash Water <br />Sterno w/Chaffing <br />Dish <br />J <br />oiiwr <br />Title <br />Names of <br />Anol mA <br />“Important** <br />Culling Board <br />Rinse Water <br />| Propane Tank <br />Soap dispenser --------- <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Pa0d 8 of 11 TEMP EVENT <br />07/3/17 <br />11. I <br />XrX SANJOAOUIN <br />------COUNTY------ <br />\ OGrjjr / <br />'^i-ti-o^ Grcolness grows here. <br />10. lam 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 />JZJIce chests ^0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ___________________________________________ _________ <br />^fWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />P One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />responsibl^persons to be present in booth during all hours of operation: | j i' > Li n cfe K ) Aa (ArrW / <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 />thlsevep^/ x.. ------------ <br />Date