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L-nvironmontal Health Department <br />10 <br />11. <br />OR <br />12 <br />1 | Waler supply dispenser with warm water at a minimum of 100"!' (i.e. 5-20 gallon container with spigot). <br />J/fone separate tub (bucket or basin) for the collection of rinsc/wastewater. <br />t<fPapcr towels and piimp-style soap container. <br />13 <br />14. <br />II'jpur Hard I <>««<• s <br />JiQ I <br />Ice Cooler <br />I ( MP I VI Nl API* <br />p-iic Water <br />3-/ 2. I: <br />Date <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[ ] Three compartment sink <br />S’.crno w/C’iaMmu <br />Dish <br />S.Wi/cr <br />UIv.Hh A .vah’i <br />MWflWprty dtf’is <br />f tooth must bo on <br />Concrete. Asplm’l. <br />Plywood, or a I nip <br />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 />J^Oelergent, bleach, and wiping cloths (cleaning towels) <br />^Tub to store wiping cloths in bleach solution <br />I am providing (he following cold temperature control for the cold holding of potentially hazardous foods below <br />Ab'T (if food is used the following day. maintain below 41T temperature) <br />Xflcc chests [ I Refrigerator <br />( | Refrigerated truck i I Ice bath and tubs <br />[ | Other (specify)______________________ ________________________________ <br />V (>3l U3V’ <br />WasteAMtc* nv» <br />Garbage <br />Gan <br />I I <br />t ini id-os' <br />OG'ign'j <br />SAN JOAQUIN <br />I . • <br />| CuHmiB llonrif <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator throe weeks prior to <br />•la/cltoii Avonup I Stockton Calilomi.i 952(1!. ) I 709 4Ga ?.4:>() I I 2(»:i •KM 01 .'■« I w.vw *.|<|ov orcpolid <br />Pagu 8 Olli l(M!*'V!N!A! <br />5 /0 Gai <br />i iiuki w«ah wnic< <br />lAf 7 <br />title <br />[ i’io|i;inr lank <br />f Sv.tr <i>spi»M-< j <br />| | II cadi ano Waler <br />f l.u.> \ <br />| I'rvojne Stovu <br />I •b.i Ke IMyi & I o>tl 6c I <br />stwed C «kI c» i'H <•> Me ttoutol1 <br />Names of responsible persons to be present in booth (hiring all hours of operation-. <br />~J2< c 4 5- / Af3 r_____C Ki 2^^ - c’ ‘1 ’ W V__ _________ <br /> <br />••iinportarit** All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event ’ ■ <br />preparation and operation. <br /> <br />/ . / Signature <br />| lllcicl. <br /> L <br />| Sono and Waler <br />I .ro I ■low) ••Imx <br />[ Health Permit