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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Completed by.I14.Date7TitlePre <br />Health Permit P^ccHnndTcMis <br />Soap <fispensar <br />Bleach <br />icrr4* <br />Fbv ExOnputeher <br />T1 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-20 Gai. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo wZChaffing <br />Dish <br />5 Gai Hand wash <br />W iviwatef Cantetner <br />Garbage <br />Can <br />SaraSzer budtrt- <br />tjfcs-t & 'MKIBt for <br />saoring wiping cfctfs <br />SAN JOAQUIN <br />COUNTY <br />6 <br />I Cutting Board <br />Propane ^ove | <br />**important** <br />Ice Cooler ( <br />___y <br />1 the followin9 ““ 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 />J^f Ice chests □Refrigerator <br />□ Refrigerated truck ^^Tce bath and tubs <br />□ Other (specify) <br />209 464-0138 | <br />[ to Baff» « Contai^naibo H <br />186e E. M. Avenue I S^.n, C.-.mi. 9«»! T ' F <br />EHO AS-O2 <br />06/29/2023 <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 />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />□ Three compartment sink. <br />Bleach and Water <br />PropaneTank I <br />Water supply dispenser with warm water at a minimum of 100°F (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 />Names of responsible/Sersons to be present in booth duringall hours of operation:_______Z------------------------------- <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 nyfatirow Efetrffn original to festival coordinator three weeks poor to <br />5 Soep and Water RtnsaWater <br />[ ^Ora \ <br />| Water