Laserfiche WebLink
Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />‘‘Important** <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels1Culling Board <br />Propano Stove <br />fl <br />Propano Tank <br />Bleach and Water <br />TEMP EVENT APR <br />Signature <br />Stomow/Chatflng <br />Dish <br />Extra <br />Water <br />6 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Sanitizer bucket­ <br />bleach & water lor storing wiping cloths <br />*'1. <br />10. <br />Plnso Water I <br />Ice Cooler <br />ceo <br />Title <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T <br />EHD 16-02 <br />07/3/17 <br />" 209 468-3420| F 209 464-0138 | <br />PagaOofll <br />I <br />6-20 Gal. <br />Hand wash Waler <br />2z <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />nreparation 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 prloi_to <br />th|sevent ,/H } ___ 04/10/24 <br />Date <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />S 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 />Q 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 />Q Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[3 Raper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Mohamed Abdallah ________________________ <br />E^tra Ico Bag! i Food Conttlners must bo I <br />stored 6 Inches oil o/ too gmndl J <br />| So»p dispenser | ---------- • <br />Bleach k 1 <br />30 <br />X-SAN»JOAQUIN <br />I"' •I -----COUNTY------ <br />G/eotnt’ss j/ror/s 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 />Q Ice chests Refrigerator <br /> Refrigerated truck Q Ice bath and tubs <br /> Other (specify)----------------- -------------------------------------------------------------------------------------------------