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Environmental Health Department <br />10. <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 />13. <br />**linportant** <br />14. <br />fitorno w/Chnffiiui <br />| IMoach <br />I'ropano Stovo <br />(Honc-li mid Wntor <br />II MI’liVI Nl Ari’ <br />Vc <br />!> (ini I kind wnaii <br />Wastowntor Conbilrior <br />Garbage <br />Gan <br />Siinitiz.or buckot- <br />bloar.h A wntor lor <br />storlno wiping cloUi.n <br />Booth must bo on <br />Concrolo, Asphalt. <br />Plywood, or a Tai|». <br />6-20 Gnl. <br />I land wnsli Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />** <br />Ice Cooler <br />SANJOAQUIN <br />COUNTY <br />(iit'iiit-i'Vi htie <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 41T temperature): <br />□ fee chests Afl Refrigerator <br />□ Refrigerated truck I J Ice bath and tubs <br />El Other (specify),_ <br />I'iipor I Imid l ow<ih | <br />I <br />Hinso Water <br /> <br />36t to inspection. Please make a copy of this application in <br />:6py of this checklist must bo in the booth at all hours of <br />J^oturn original to festival coordinator three wpeks prior to <br />,___________K Title ~ Dato/<" Z <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 />[. 1 Dotergent, bleach, and wiping cloths (cleaning towels). <br />171 T ub to store wiping cloths in bleach solution. <br />| Soap dispoiMor <br />| I’ropnnoTmik <br />I xtiu Iccllarjs f. l oorl CoiiI.iIihm mist he ■! <br />stored 6 Indios oft ol the gnnmdl ! <br />1868 IHazelton Avenue | Stockton, California 95205 | T 209 468-3420 | I- 209 464 0138 | www.sjcehd.coni <br />lil ID 16-02 Pago I) <>( 11 H-.MP !:V!:N1 <br />07/3/17 <br />| | One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q^apor towels and pumprstylp_spap container. <br />Names of rosponsiblp persons to be-nresenUnjiooth during all hours of operation: <br />___________ <br /> <br />All food vendor boothsprosubj <br />preparation for this ewpt <br />preparation aaZoperatiori. <br />this ovq4k <br />Completed by: /C <br />Signature <br />| I loalth Permit <br />f Cuuklfl lten«l <br />| fio.’ipmnl Witter || <br />I ini rxllnqul'.linr I