Laserfiche WebLink
Environmental Health Department <br />10. <br />Ou <br />11. <br />OR <br />12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by:14. <br />r Signature <br />Health Permit <br />Papwr Hand Toweis <br />Soap dispenser <br />GuUmg Board <br />Bleach <br />Propane Stove <br />I <br />Propane Tank <br />Uleucli and Water <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: 42 ft v f 'Vi xKr'n csn <br />fzit/a Ico timjs S / ood Contoinun iiiiiaI bo <br />alorod fi Indios oil ol Ihu uioumil <br />Slemo vr/Chaffmg <br />Dish <br />txtra <br />Waler <br />6<ial Handwash <br />Wastuwatur Conlalnor <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />SaniUzerbuckal- <br />bieach & waler tor <br />storing wiping cloths <br />Title <br />_z <br />Soap and Waler Rinse Waler <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T <br />EHD 16-02 Tr- “ - <br />07/3/17 <br />Z- x I Fire EtdingulslwiCH <br />Date <br />" ■ - 209 468-34201 F 209 464-0138 | <br />Page 8 of 11 <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />SAN JOAQUIN <br />I - I COUNTY <br />‘ Yr rro‘.’'''V Cut’Ofness iJfOIVS Ill'll . <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 /> Refrigerated truck Q Ice bath and tubs <br />pother (specify) xOqCaS___________________________________ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Th.Be compartment sink. A 1 <br /> Three deep tubs (basins 6-8 indnes 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 />Names of responsible persons to be present in booth during all hours of operation: <br />Anwtfvx ___________________________________________________________ <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 anioperation. Return original to festival coordinator three weeks prior to <br />this