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SAN JOAUUIN I tivironmr.'iit.d Ho;dlh ) inu.rif <br />io <br />11 <br />OH <br />17 <br />[X| Waler supply dispenser with warm water al a minimum of 100T (i e .'>-20 gallon container with spigot) <br />Xl One separate tub (bucket or basin) for the collection of rinse/wastcwatcr. <br />XI I’apcr towels and pump-style soap container <br />13 <br />"Important" <br />Completed byId <br />Signature Title Date <br />I'.IPV' H.u I Icars <br />Soup cMpOOM i <br />l’*i i ,r.i' Sto-.o <br />CjJ I <br />Soar .irvl •I It. w t- a-v.l W.i*i <br />I re I Mi'UmVvv <br />Ice Cooler <br />' •'•J kc U.hjS A / fiul l.iinfs hr <br />vhi/i J ii*f t / n f <br />Names of responsible persons to be present in booth during all hours of operation: <br />Luis Elizondo <br />I am providing the following for adequate hand washing facilities, but separate from ulensil wash within my <br />booth: <br />[ | Three deep tubs (basins 6-8 inches minimum), one for soapy waler, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of waler). <br />[ | Detergent, bleach, and wiping cloths (cleaning towels) <br />[ | Tub Io store wiping cloths in bleach solution <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I | I hree compartment sink <br />Boolh must tie un <br />Concielt: Aspluill <br />Plywood or a I,up <br />St'.wo wlC'iathoq <br />O»l> <br />'j GtUH.itul w.i »• <br />Giutuifji- <br />Can <br />S;nHlizr> I <br />blc.xh A *»•!«*’ fv* <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />df> T (if food is used the following day, maintain belov/'ir'l temperature) <br />[ | Ice chests | | Refrigerator <br />[ | Refrigerated truck [ ] Ice bath and tubs <br />!X| Other (specify) Honey is a non hazardous food <br />5 .1> I..T <br />i Ha-xl <br />W.-A. ■ | p. ■(< . ■ ; <br />f mp i vi m z.pp <br />■ ' I |.i/< lloi: '>v. I,;| (■;,.] fn;|V.| <br />fit!) to 0? <br />c■tn ?0Z4 <br />, I ?o'i '!f: : .:•> m ; I .'.p. .'i.-: , t '.>• <br />I,.<q<- 0 O' I 1 <br />All food vendor booths arc subject to inspection. Please make a copy of this application in <br />preparation for UHs event A copy of this checklist must be in the booth at all hours of <br />preparation andpoperation Return original to festival coordinator throe weeks prior to <br />this oyont^j^. Owner 12/26/2024 <br />| r’uttrm H ).»rd <br />| I lealth Permit