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Environmental Health Department <br />G i < g ',j i <br />10. <br />NJk 11. <br />OR <br />12. <br />|Hj Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />OS] 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 />Papct Hand TcvmIs <br />Scutp <br />Cutting Bo<Md <br />BeachPropane Store <br />]T x <br />Eteasii zrd VAUbt <br />Rn- EidnQusher <br />I <br />1868 E. Hazelton Avenue | Stockton, California 95205 j i 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />TEMP EVENT APPPape 8 of 11 <br />Sieroo •u'O-feg <br />Deh <br />EHD 1M)2 <br />05/19/19 <br />I am providing Ute following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sanitixef bucket. <br />sXto-.g ui^ng dons <br />Garbage <br />Can <br />Booth must be on <br />ConcrEie. Asphalt. <br />Plywood, ora Tarp- <br />SAN .JOAQUIN <br />-----COUNTY <br />Eiira <br />5 G— Hand wash <br />Z• <br />Ice Cooler <br />^60 <br />**lmportant** <br />0 <br />Title Date <br />I <br />Scop and VAW Rrartia <br />Health Permit <br />Hr re. <br />1 the fo,lowing temPerature control for the cold holding of potentially hazanious foods below <br />Propane Tack <br />Eura too OiQi i Food Contanus rnsl t« S <br />aomd e inejnrs att ot the ground' 'A <br />lam 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 />O Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />45°F (if food is used the following day, maintain below 41 “F temperature): <br />® tee chests [J Refrigerator <br />HU Refrigerated truck foe bath and tubs <br />® Other (specify) _____________ <br />[k" <br />5-20 Gai <br />Hand wash Water <br />J 0 (K <br />Names of responsible persons to be present in booth during all hours of operation: <br />O ______________________________________________________________ <br /><». \\ \ \c. ______________________ ____________________________________ <br />AH 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. <br />;___________QO <br />Signature <br />•z;. »t*