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■ <br />Environmental Health Department <br />10. <br />11 <br />OR <br />12 <br />13. <br />••Important" <br /> 2#patu^14. <br />Heaitn Permit <br />P«0«r Hand Tcn«u <br />[ Cugi-q Bo«e | <br />Oio*cn <br />K. .. W.i« <br />Ice Cooler <br />1868 E Hazelton Avenue | Stockton California 05206 | T 200 468-3420] F 209 464 0138 | <br />PwonOof II <br />Title <br />Stwno t^Cr-aff^Q <br />Don <br />5-20 Gal <br />mc.-« V.Hw <br />Booth must oe on Concmts. Asphalt. Plywood, or a Taro <br />S U4. IWM Muh <br />CU‘S»« <br />GartMtao Can <br />3m»m> sucw <br />Mmco t ataw Um <br />ttorng w jwiy ocmi <br />Completed Dy.-- <br />ehd isoy <br />0imi3Q7A <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />ZS Three compartment sink <br />Q 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 />www sjgov org'ehd <br />TEMP EVENT APP <br />I f I <br />£j!'4 Ka I faott Cotttenft <»u9l be ■ <br />Mix-1 fi irrche* t/i ai Hu Qi’WKjt ■ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />QWater supply dispenser with warm water at a minimum of l00°F (i.e. 5-20 gallon container with spigot) <br />^One separate tub (bucket or basin) for the collection of nnse/wastewater. <br />Vi Paper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation <br />U ir hrk-e 1 a A l<oYi c ________________________ <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for Jhis. event A copy of this checklist must be in the booth at all hours of <br />preparation aifd operation Return original to festival coordinator three weeks prior to <br />I Soep <1 MXXiew I _____ <br />I BwtnrdWMr | <br />0 f <br />-.h ■ • y.-l . <br />. ..i, . . .r5~- <br />SAN JOAQUIN <br />------COUNTY------- <br />Grrotnes’ grant here. <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 /> ice chests ^Refrigerator <br /> Refngerated truck Ice bath and tubs <br /> Other (specify)_____________