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Environmental Health Department <br />10. <br />11. <br />OR <br />12.boothPr°Vidln9 016 fo,,Owinfl for ade(ltlate hand washing facilities, but separate from utensil wash within my <br />13. <br />14.Completed by: <br />Ignaturo <br />Health Permit <br />Popor Hand Towote <br />Cutflno BmtJ <br />Frdpaiw Stovo <br />P.-opono Tank <br />EHonch and Waler <br />X <br />'Water supply dispenser 'with warm water at a minimum of 100‘F (l.e. 5-20 gallon container witli spigot). <br />One separate tub (bucket or basin) for the collodion of rlnse/wastewater. <br />Star no w/CtiaKnq <br />L'l^> <br />3 Gal Hand wash <br />WustewUiT ConWnoi <br />Garbage <br />Can <br />Saniteor bt>cin» <br />Uaocn & water hr <br />"loHng wiping elolhs <br />Wrs <br />Vlalor <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Torp. <br /> [ Blaadi <br />Ice Cooler <br />Qraper towels and pump-style soap container. <br />Names of responsible persons to be present In booth during all hours of operation: <br />— ____________ <br />■ SAN JOAQUIN <br />: J - ------COUNTY------ <br />ror-. Greatness grows here. <br />1 am0Pr°vidin9 the following cold temperature control for the cold holding of potentially hazardous foods below <br />45J= (if food is used the following day, maintain below 41 °F temperature): <br />0lce chests Refrigerator <br /> Refrigerated truck ice bath and tubs <br /> Other (specify) _____________________ <br />•‘Important"* <br />5-20 Gnl. <br />r- Hand wart Wafer <br />Soan dtaponaor ____\ <br />EHD6?(^2HaZe1t°nAVenUe| Stockton’ California 95205 | T 209 468-3420 | F 209 464-0138 | www.slgov.org/ehd <br />05/19/10 Pago U Of 11 TEMP EVENT APR <br />fc'.tfrB lai * Food Cunhilnm^ imsl bo <br />etoratf S ftwies olfot the grouiKil <br />lam providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />ItZfhre© 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 />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 andjjpgratlon. Return original to festival coordinator three weeks prior to <br /> fhisevenU^_____ <br /> <br />Title Date <br />.Aaiu.,. <br />I Snap oral y/olor Rinso Water <br />I Rra KullriflutehBr I