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Environmental Health Department <br /> <br /> <br />10. <br />11 <br />OR <br />I <br />12. <br />Signature <br /> <br /> <br /> <br />?- <br />‘W.’',1 <br />j,,; <br />Sirieio wfCr^ff’OQ <br />0»«h <br />u <br />Hearth Permit <br />I <br />|r[S <br />I <w <br />_iL 7~3m_« <br />I CmniltKrt <br />| Profit ciurrt> ^ , <br />I <br />- - 1 ; ■---I <br /> ■ ^||O I <br />4nsaj <br />L ^ss> j ^=, ; <br />flQiisMilisteai <br />14. Completed by: <br />Water supply dispenser with warm water at a minimum of 1 GOT (i.e. 5-20 gallon container with spigot).. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />Nam« of fosoo^o po^ns^pyoo. >0 poo.., dodo, o', hoy, of ope^. , _ <br />V ———■—————-. ■; ■:■ .; <br /> <br />this event Q ^.l A>€X_ ___ <br /> ' , • p7' ek ■' I' <br />______\ •> <br />Sew «■»>••>•« | -----------1\ . <br />SAN JOAQUIN <br />-----COUNTY------ <br />Cj •' i • ~ r * • * i •'1 '' <br />i am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45CF (if food is used the following day, maintain below 41 F temperature). <br />{Xf Ice chests ET Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)___---------------------------------—--------------------—-—- <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q^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 />b00'h' -j <br />-^FT E <br />1 ..___7_T_ ,_L__