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Il- hvii iro ru n 111 e nfeiIIII a8th pa ri:m g nt <br />io. <br />11. <br />OR <br />12. <br /> Paper towels and pump-style soap container. <br />13. <br />‘"Important*' <br />14.Completed by. <br />Health Permit <br />Paps< Hand Towels <br />Culling Board <br />/Propane. Slovc <br />0 <br />Propane T ank <br />Ice Cooler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) l: 209 464-0138 | www.sjcehd.com <br />EHD 15-02 Page 0 nl 11 TEMP EVEN ITEMP EVENT APP0’73/17 <br />Tl <br />0. ri <br />T2^Water supply dispenser with warm water at a minimum of 100°F (i.c 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra tee Ua:js 6 Food Contamen must be <br />stored 6 ott o' the ground! <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this even! <br />preparation ai <br />this event. <br />Slcrno w/ChaH„ig <br />Dish <br />5 Gal Hand wash <br />Waslew.-lar Container <br />5-20 Gal. <br />Hand wash Wainr <br />Garbage <br />Can <br />Ssnilizei bveket- <br />blccch & water !or <br />storing wiping ctotlir. <br />Boolh must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Title <br />SAN JOAQUIN <br />C OU M l Y <br />nW <br />A copy of this checklist must be in the booth at all hours of <br />nd pperatiorj Return original to festival coordinator three weeks prior to <br />ll ftlN vJL l‘2 <br />signature P Title Date ' <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />hree 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 cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 4IT temperature): <br />T^lce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) _____________________________________ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />—jl <br />Names of responsible peisons to be present in booth during all hours of operation- <br />YAATTvAtvQ UkkJ______________________' <br />| Soap dispenser j <br />I k <br />r V31^11[ <br />Fire Cwlnfliilshcr