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4155340150 p.414-Sep-Z017 18:Z9 <br />Environmental Health Department <br />to. <br />11 <br />OR <br />12. <br />Paper towels and oump-style soao container. <br />lames of responsible persons to be present in booth during all hours of operation:13. <br />“Important** <br />14.Completed by: <br />/ Daw/ <br />1 Urc T OMsli <br />Ptocwne Sitowi <br />J^racrtn® Tajik <br />ord VWcr <br />»-'tre Ejcutjxtots'w <br />Received Time Sep. 14. 2017 4:21PM No. 2303 <br />Ot*h <br />txx-xc,’ <br />A fix <br />w»po\i LxXrte <br />Booth miict be on <br />Concrete. .Asphalt <br />Plywood, or s Tarp <br />Q Ice chests <br />O Refrigerated puck <br />□ Other (specify) <br />Em <br />WabM <br />s,2v am <br />l-UttO winth. VVAhtx <br />S Qa) Hand wash <br />WaftKjnvwrw Ccinuxrwr <br />Garbage <br />Can <br />ice Cooler ? ’ <br />_______F <br />SAN JOAQUIN <br />..... C i - J ;■ y....... <br />J <br />iperatisyi J <br />Sl^ature <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth. <br />Water supply dispenser with warm water at a minimum af 100°F (i.e. 5-20 gallon container with spigot). <br />ra one separate tub (bucket or basin) for the collection of rinseAvastewater. <br />P Health Permit <br />Jam providlag the following Items within my booth for the sanitary cleaning of food preparation utensil <br />LSsl hree 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 />□ Detergent, bleach, and wiping cloths (cleaning towels), <br />LJ 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 />45T (if food is used the foilowing day, maintain below 4rF temperature): <br />^Refrigerator <br />Fl Ice bath and tubs <br />_ <br />£xtnt -Vo tJafya A .4-\xxJ C-^nlairKKnt ntuM b» <br />oKjrwd d irtafm off of fhs». jhococf <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 ail hours of <br />preparation and operation. bflflfoal ft? fgstival coordinator thro? vmks poor to <br />' ~x'y fa——- 4- Z-k: -is T2- <br />Title <br />I Soap dis^ar^ar <br />tt**T 'f" <br />TZ <br />Scop and Waiw <br />CiXtrv fiiwiU