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Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />13 <br />-Important*’ <br />14.Completed by <br />Health Permit <br />Pac« Hjr-3 rowBii <br />S'XK’ <br />Prcwr-e Sio-e <br />I <br />P-zo^ys Td"* <br />R .->«> Watw ard‘.’.\Her <br />/F«re t »'<c.-Vx-r <br />Ice Cooler <br />O 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 nnse/wastewater <br />wiO-aSisj <br />O'V- <br />5 Gai Hana wash <br />Waa'fwxcr Ccn.’a/-w <br />wa"a sjgov org eno <br />TEW EVENT APP <br />Sar>f_'a- Dwcko! <br />6«acn 1 *at«' ’c« <br />VO" rg *<.n} cctTn <br />Booth must be on <br />Concrete Asphalt. <br />Plywood, or a Tarp <br />Ke I ^-vx: Cjy^vnert rruV 0c <br />t*y«r S nzrtei eft of .-e yet^no' <br />S2C Gai <br />r3 wa«n W*w <br />Garbage <br />Can <br />v.'jeib- <br />Title <br />oq-2<£*-2oZ3 <br />Date <br />Ss*s ar-j W*re« <br />1868 E Hazeiton Avenue | Stockton California S5205 | T 209 468-342C I F 2Q9 464-0138 <br />EHO 16^2 Page 0 of 11 <br />06’SIS <br />uZ^7 <br />Signature <br />CEi Paper towels and pump-style soap container <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink <br />Q 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 />LJ Detergent, bleach, and wiping cloths (cleaning towels) <br />l_J Tub to store wiping cloths in bleach solution <br />Ail food vendor booths are subject to inspection Please make a copy of this application m <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. . ^7 7) T' <br />SANJOAOUIN <br />COUNTY <br />Greatnru jrcwi here <br />I am providing the following cold temperature control for the cold holding of potentially tiazardou’; foods tx?fcw. <br />45 F (if food is used the following day. maintain below 41T temperature) <br />&ce chests Q Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />Names of responsible persons to be present in booth dunng all hours of operation <br />l^arn^provndmg the following for adequate hand washing facilities, but separate from utensil wash within my