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Environmental Health Department <br />10. <br />11. <br />OR <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 />Important** <br />Completed by: 14. <br />Health Permit <br />IPape' Hand f oacis <br />Soap dispenser <br />lueachPropane Stove <br />Propane Tank <br />I i.'o I •i nguisncr <br />Ice Cooler <br />TEMP EVENT APT* <br />Signature <br />Slcrno v»/C’iattnQ <br />Dish <br />5 Gal Hand wash <br />Waste water Container <br />Garbage <br />Can <br />San. tizer bucket <br />blcaUi i water for <br />Storing >vpng cloths <br />Booth must be on <br />Concrete. Asphaft. <br />Plywood, or a Tarp <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 />y] Detergent, bleach, and wiping cloths (cleaning towels). <br />yC] Tub to store wiping cloths in bleach solution. <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 41 °F temperature) <br />p4 Ice chests Refrigerator <br />O Refrigerated truck Ice bath and tubs <br />[~] Other (specify) ____________________________________________ <br />I >l'a Ice llagi A I cod CO'djincri znusf be <br />iloicd 6 ncbcs ollol the ground1 <br />I.>113 <br />Walci <br />5 20 Gai <br />Hand wash Walc< <br />11!68 I <br />i no i6-o? <br />06/19/19 <br />SAN JOAQUIN <br />,.11. : <br />-■! <br />e. £>, <br />Title <br />R.nsc Water <br />Hazelton Avenue j Stockton California 95.Z()5 | T 209 468 3420 | I 209 464 0138 | wvav sjgov ory/chd <br />Page 8 of 11 TC.V" <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: ArJ^ <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />L <br />Soap and Water <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 /> <br /> <br />tiatd" <br />Names of responsible persons to be present in booth during all hours of operation: <br />K-/ f r <br />Cutting Eloard