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Environmental Health Department <br />11. <br />OR <br />12. <br />>oth during all hours of operation: <br />13. <br />Completed by:14. <br />Paper Hand TowelsHealth Permit <br />Soap dispenser <br />Bleach <br />I Propane Tank Bleach and Water <br />Fire Extinguisher <br />A <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />* - | T 209 468-3420 | F <br />Page 8 of 11 <br />Soap and Water |Rinse Water <br />I Extra ' <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Cutting Board <br />Propane Stove <br />sanitary cleaning of food preparation utensil <br />Z'.c.e Cooler <br />1868 E. Hazelton Avenue | Stockton, California 95205I <br />EHD 16-02 <br />07/3/17 <br />209 464-0138 | wvvw.sjcehd.com <br />Important** <br />I Sterno w/Chaffmg — <br />Dish J <br /> One separate tub (bucket or basin) for the coliection of rinse/wastewater. <br /> Paper towels and pi imp-style soap container. <br />All food vendor booths are <br />preparation for this event. preparation ^nd-cperation. <br />this event <br />Extra Ice Bags S Food Containers must be <br />stored 6 inches off of the ground! <br />-------------Titi^ bate <br />< Signature <br />SANJOMUIN <br />T (site ' ------COUNTY------- <br />Greets -.r e for cold hoWing of potenbaliy hazardous foods below <br />10- 1 Ts^food !s eus"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 the following items within my booth for the <br />«—- »■ - - m “ <br />booth: