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Environmental Health Department <br />11. <br />OR <br />12. <br />13. <br />-+ <br />‘‘Important** <br />14.Completed by: _ <br />If'npof I kind lowols <br />IICntlinil llon-d <br />[ lllo.-ichProp,inn Slow <br /> <br />—I'Yi.-Vnn.'; J1 <br />I Hooch mid V/ntor <br />Ice Cooler <br />LI Ono separate tub (bucket or basin) for the collection of rinso/wastewater. <br />L^apor towels and purnp^s.tylo_spap container. <br />LI 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 />filorno wA'hnfllng <br />Dinh <br />!>Gnl Ihindwnsli <br />Wrislowalor Cnnl.dnor <br />Garbage <br />Can <br />Sanitiznr Imckol- <br />blnndi A wator for <br />alorlno wiping c.lotlin <br />Uoolli must bo on <br />Concrnto, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Lf^A/ater supply dispenser with warm water at a minimum of 100T (i.c. 5-20 gallon container with spigot). <br />1868 I -:. Hazelton Avenue | Stockton, California 95205 | T 2.09 468-3420 | F 209 464 0138 | www.sjcohd.com <br />mo Ki-02 I’ajjonofll fl.MI’liVI Ml API’ <br />(I//VIZ <br />SAN.JOAQUIN <br />COUNTY <br />SJgiiflhp'c <br />6-20 Gnl <br />I land wash WnMr <br />Hinsi > W.iicr | | <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 />this event. / ) / i / <br /> (Jk>he< <br />Title Date <br />I I loalth Permit <br />I aniproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />I yKhree compartment sink. <br />| Soap mid Wirtar | | <br />Names of responsible persons to bo present in booth during all hours of operation: <br />DaV e _________ <br />' I hch.i Ice Dmjs A l ootl Cnnl.ilneis nuKl /><! <br />stored 6 Inches ell at the gioundl ; <br />| I’loptmo Tmik <br />| :-.o;ip disponsM <br />| Sonj <br />tiro Exilnnulshor | <br />(>i lUil ■■•cs■> <br />10. 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 tempcraturo): <br />[✓flee chests | .•'t^frigerator <br />LI Refrigerated truck Ice bath and tubs <br />LI Other (specify) f f