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Environmental Health Department <br />10. <br />lifaty cleaning of food preparation utensil11. <br />OR <br />12. <br />13. <br />**Important** <br />Completed by:14.u Date <br />Health Permit <br />Paper Hand Towels <br />CutlrOH j <br />BfeachPropane S',ova <br />j PropaneTank <br />Fire Exlingulslier <br /> <br />Q <br />Ice Cooler <br />Slamow/CbaNIna <br />Dish <br />Garbage <br />Can <br />5 Gai Hand wash <br />Wastewaler Container <br />SeniSzcr buckel- <br />bteach i waler for <br />sloring wiping dolhs <br />iunng <br />Signature Q <br />1 ------------------ <br />Booth must be on <br /> Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I Soap dispenser | <br />Haach and Waler <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_prjor_to <br /> x ^'V <br /> <br />Title Date <br />5-20 Got <br />v- Hand wash Walor <br />I <br />■ SAN JOAQUIN <br />Ij-L -----COUNTY <br />■b t/.-rn-r-;. Il err. <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 day, maintain below 41°F temperature): <br />Q Ice chests O Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify).____________ ________________—--------------------—-----------------———----------- <br />J £rlre Ice Bogs S Bocd CortBloers must ba <br />' Blared 6 Inches off of tbo QrovncU <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | <br />ehd iG-oz Pas« 8 °r i1 r“MK fc <br />07/3/17 <br />' 77/^ <br />Soap and Water Rinse Wafer <br />I am providing the following items within my booth for the sani <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 toweis). <br />J^fTub to store wiping cloths in bleach solution. <br />1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />S^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />J^One separate tub (bucket or basin) for the collection of rinse/wastewater. . <br />JgPaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> -