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I jivironnieiit.'il I loallh Dupai inienlSAN JOAOUIN <br />10. <br />11. <br />OR <br />12. <br />| J Water supply dispenser with warm water at a minimum of 100°F (i e. 5-20 gallon container with spigot). <br />13. <br />“Important** <br />Completed by: 14. <br />Signature <br />I’apw > tiMd r o*iJi <br />| f*iopa>>c Slnvt | <br />| J HintcWA'O' | J llicnui .uki Wata <br />Ir-rc I s'>C'fr" <br />Ice Cooler W«Mv»atvr CantnrK < <br />Garbage <br />Can <br />SanrtiHW txicxot- <br />bieMii & water k> <br />stemvj meuig delis <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Carp <br />[ 1 One separate tub (bucket or basin) for the collection of rinsc/wastcwator. <br />V-f Paper towels and punip-style.soap container. <br />Names of responsible ppwons to be present in booth during all hours of operation: <br />ejrTJ <br />Sonp iM<lWate< I <br />S-W Gai <br />il.indw.>shW.T<:< <br />j 1‘iorano i ana <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 throe weeks prior to <br />ihis owm. _ <br />Title Date <br />I I: U/a Ice lijgs 4 I'ckhI Cciiljincis mutt lie <br />I noted 6 nt net o" ct ir-c grwd' <br />I3G« I- Hazelton Avonuo | Stockton California 9520!> | I 20?i'l(>3 hT'O | I ZOu .■.nd-O I ?.3 | www Sjqov oin <‘.-l <br />f:|«) l6 0? Page 8 o' 11 IliMP I-VI NF APf> <br />0//01.?0?» <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day. maintain below 4IT temperature) <br />L| ice chests 1.1 Refrigerator <br />LI Refrigerated truck . LI Ice bath and tubs <br />y\ Other (specify). .... <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I ] Three compartment sink. <br />L I 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 v^ipingclotii^loaning towels). <br />[ J Tub to store wiping clothsirTEIeach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />| iiicach <br />3ot <br />| Health Permit