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Environmental Health Department <br />11. <br />OR <br />12, <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />S One separate tub (bucket or basin) for (he collection of rinse/wastewater. <br />[3 Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed^^^^^^T^14.7 Qi <br />J <br />Health Permit <br />1 P»p«rH»n<lTow«ta <br />Propane Stov* <br />H <br />a«Kh end WMar <br />Fka ExBngUaherG <br />Ice Cooler <br />E 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 />KI Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to 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 /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sttmo wOuffing <br />OWi <br />E>*l <br />WK«r <br />Garbage <br />Can <br />SanttNTbucfcM- <br />4 water tor <br />itortng w^ing dothi <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, of a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Michael Porter <br />SGdHandwKH <br />WsMwalar Ccnudrwr <br />% SAIWOAQUIN <br />-----COUNTY------ <br />Greotncss grows here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41 °F temperature): <br />S Ice chests Refrigerator <br /> Refrigerated truck E Ice bath and tubs <br /> Other (specify)_______________________________________________—------------ <br />_z <br />Soap and Wutnr <br />rv <br />Rlnsa Water <br />Propane Tank <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 weeks prior to <br />thisuvent? _ » ■ KI <br />Am rut-Hi fl <br />Title J J/Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD1&O2 PnoeBofll TEMP EVENT APP <br />07/3/17 <br />J f Extra In Btfpi FcoO CoriMKrsaMt bo I <br />'S j sfanx/8/nc/»jo/rof(ft»grounc/T IJ <br />Culling Board I <br />nF-QU,''f o •P <br />10. <br />520 GM <br />y Hand wash Water <br />| Soap dspansar | ---------- \ <br />' k F