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Environmental Health Department <br />10. <br />S Three compartment sink. <br />12. <br /> Paper towels and pump-style soap container. <br />13. <br />14.Completed by. <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />uI <br />Bleach and Water <br />Ice Cooler <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5-20 Got <br />Hand wash Water <br />Santaer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5 Gal Hand wash <br />Wastewater Container <br />SAN JOAQUIN <br />-COUNTY— <br />oujyw <br />Title <br />z <br />Soap and Water Rinse Water <br />‘‘Important** <br />I Propane Tank I <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www sjqov oro/ehd <br />TEMPE^NTAPP <br />2lUto^oXX^o?bl^Son ofwater)16 006 3 bleaCh <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Z-X Fire Extinguisher <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: ■' <br />Names of responsible oersons to be present in booth during all hours of operation- <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 />_____fa) 1 [ibL) <br />SignatdieJ Title D^te <br />1 •the fo^inp,!:old temPerature “"‘ra!for the “Id holding of potentially hazardous foods below <br />.45 r (if food is used the following day, maintain below 41 °F temperature): <br />0 Ice chests ^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />0 Other (specify) Voojl i j p r hg <br />11- my b00th for the sanitary cleaning of food preparation utensil <br />OR