Laserfiche WebLink
Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />“Important** <br />14.Signature <br />I <br /> X <br />Ice Cooler I <br />Garbage <br />Can <br />•Homo w/Clinfhno <br />Dish <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />f rilnso W.it. r | | HlnnchnixIWsilor <br />6 (Jnl I land wiish <br />Wnslnwalor Conlalnor I <br />Health Perrnrt |" <br />/ Sanltizof huckol- <br />/ bloadi & w.itof tot <br />/ I ' storino wipli'O doths <br />p? I.*!'.'??: ‘T <br />I X||,1 le.0 IJilf/s A l oad ConMtms nitul Im •] <br />slotml 6 Indios oil d the (iioihkII <br />| propane Tqnk <br />■ f ■ t T I <br />| Soap nnd Wator | <br />| |ro I xtkioiMnlior <br />| Cutting Board • <br />f’rop.ino Slovo , <br />18681-.HazeltonAvon^o| Stockton. California952.05 | T 2.09168-3420 1 F 209464-0138 | www.sjcohd.^nt <br />I elClO II CH I I <br />I III) 16 0? <br />01/V 17 <br />j Paporlltind rowolJ | <br />SAN JOAQUIN <br />COUNIY <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 following day, maintain below 41 F temperature). <br />$ Ice chests □Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify). <br />I am providing tho following items within my booth for the sanitary cleaning of food preparation utensil <br />[/I 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 />[)<j Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />eg Wa Jl^y d^nXthta™ watmu a of WOT (i.o^Sg^on container with spigot). <br /> one separate tub (bucket or basin) for the collection of rlnso/wastewater. SeuueZ <br />l/J Paper towels and p_iirnp.-style.spap container. <br />Names of responsible persons to bo present in booth during all hours of operation: _ <br />CToc ---------------------------------------- ~~ <br /> <br /> <br /> titisgy^ ,_______ <br />Completed by: ---------------------------------------------------Title Oat0 <br />i 5-20 Oal. <br />I Innd wnsfi Wnlor <br />| Soap disponsoi |---------- \ <br />[ lllonch I