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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <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 />13. <br />Completed by: 14. <br />[nature <br />Health Permit <br />Paper Hand TomIs <br />Soap ckapanaar <br />BlaacnPropane Stove <br />Propane Tar» <br />Fn Ednouaha <br />I Ice Cooler <br />ins <br />•> s-.-; <br />ban <br />waw <br />SJamo aOafSno <br />Dish <br />5-20 G* <br />Hand wash Water <br />Sanuzar buctart- <br />tMachAwMartor <br />stonng wiping cMhe <br />SGtfHanaMMT <br />WMaaaMrConaror <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Gartwge <br />Can <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp <br />I- <br />Date <br />Baach and WaterSoap and Water <br />1 ____7 <br />j Rinse Waa* <br />** Im porta nt** <br />-------------—K I MrwrfMtweartffiafiKMMf ■ <br />1868 E H»eton Avenue | Stockton. CaStana 96205 | T 209466-34201 F 2094644)138 | www.spewxorEHD1W): ■rew’tvtw <br />n7/5H- ' <br />TtUe <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />171 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 /> Detergent, bleach, and wiping cloths (cleaning towels) <br /> Tub to store wiping cloths in bleach solution <br />SAN.JOAQUIN <br />------COUNTY------ <br />Grcuinesi grc<v$ hprr <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 />0 Ice chests ^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <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 />this event — <br />Names of responsible persons to be present in booth during all hours of operation: <br />'TO'^YXS . ffcRNV. SftLDfirUZl__________ <br />Cuttng Board