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Environmental Health Department <br />10 <br />11. <br />OR for soapy water, one for rinsing and one for a bleach <br />12 <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by.14. <br />Health Permit <br />Pape Hanu lewes <br />Propene S*o»» <br />it <br />Propane <br />Ueain k) Wjw <br />1> Vtt I dU^lUM <br />Ice Cooler <br />Page 8 crt 11 TEMP EVENT APP <br />Cure •» <n>u» & / iiuk <br />Soreo 6 rnJxn <rf> <X v>o vtuurKf <br />Swno '•rfdioffing <br />Otth <br />5 (»n Hand <br />Waucwatu Cuntxnei <br />520 Gaf <br />Hand wasn Watei <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />^Signature <br />SaraBzer Ouaut- <br />Ueacn & mum to> <br />sttxino Mpng dwm <br />SAN JOAQUIN <br />------COUNTY— <br />Bleach <br />I am proving the followmg rtems within my booth for the sanrtary clean mg of food preparation utensil f\J ft <br />[~] Three compartment sink <br />I <br />Soup nod W»l<> <br />IL5 <br />Itatto Wutei <br />“Important** <br />I Soap dupemei <br />1 P™ haM'd°U5 bel°W <br /> Ice chests Reftigemhx <br /> Refrigerated truck bath and tubs <br />J3 Other (specify) /\ _/j----------------------------------------------------------------------------------------------------------------- <br />3 <br />EHD 86^2 Ha2elt0n Avenue I stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />Page 8111 ™EV«iTA! <br /> Three deep tubs (basins 6-8 inches minimum), one <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 fadlilies, bul separate from utensil wash withm my <br />booth: fxj |\ <br />Q Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />Nppies of responsible persons to be present in booth during all hours of operation: <br />NZUdAZ_______________________________________J <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 />thisevefA .. 0 ^>1 9 -^> I 2 011/ <br />Title Date '