Laserfiche WebLink
En v i to 111 ne nta I Health Do pa ill t tout <br />10 <br />11. <br />OR <br />12 <br />13 <br />•'Important** <br />14. <br />Signature <br />1 I'.iptr Hand I lacU <br />I. <br />Rinse W.1IC/ <br />Ice Cooler <br />Owner. <br />Titlo <br />Stcrixi w/Ciiann:; <br />IMh <br />Gaibagc <br />Can <br />San-bzo bucket <br />bleadi A Mtci ’u' <br />Moing a f.ry clottlS <br />Booth must be on <br />Concrete Asphat <br />Plywood, or a I arp <br />!» X) G» <br />Hh t<l w.ish Water <br />5 (ial l t.vvl v.a Vi <br />Wastewater Cor'Uwr.vc <br />SAN JOAQUIN <br />• 11 . • <br />| j HtOiKh iml Wata <br /> <br />| Pfopace t.n* <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[ | Three compartment sink <br />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 />■„ | 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 />[\j^Vater supply dispenser with warm water at a minimum of 100T (i.e 5-20 gallon container with spigot) <br />RYGne separate tub (bucket or basin) for the collection of rinse/waslewater. <br />Paper towels and pump-style soap container. <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 daty. maintain below 41’1- temperature) <br />| | Ice chests H Refrigerator <br />| | Refrigerated truck [ ] Ice bath and tubs <br />[ ] Other (specify)___________- - - <br /> <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 three wooks prior to <br />this_gvont 04/15/25 <br />Completed by:t Owner. <br />Date <br />Names of responsible persons to be present in booth during all hours of operation: <br />Assia Khalil, Bashir Sadat, David Hasieb <br />j SMp d»|>o>'SV' <br />| Hw >• <br />It’.ii.-: I lla/v tun Avenue | Stockton Calilomia 9.'>.d)fi | T 2U9 4fiB 3420 | I 209 •I(i1 0138 | www sjrjov org/ehd <br />I III) 16-02 Pago fl ol II 11 IVIN I API’ <br />(XV19/ ’9 <br />I di.i lev ILigi 41 ooil Cor-'j'Wn '<».»» tic <br />Sftwctf 6 "nhe tvtlot the </• o<e.d' <br />| I'rmi.if'c Steve <br />( Soap ami Water | | <br />I ifQ | J <br />| Health Permit j <br />Ci.'Vij Hc.ihI |