Laserfiche WebLink
SANw]UAQU N Environmental Health Department <br /> 1 LW <br /> l; (—,I t ti i r <br /> 10 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 4 F(if food is used the following day,maintain below 41°F temperature) <br /> Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑ Ice bath and tubs <br /> ❑Qther(specify) <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink <br /> OR <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 /> 13etergent,bleach,and wiping cloths(cleaning towels). <br /> IN Tub to store xiping cloths in bleach solution <br /> 12. 1 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 of 100°F(i.e.5-20 gallon container with spigot). <br /> Xone separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ,Paper towels and purnp-style soa container. <br /> 13. N mes of responsible�} °i1s to be present in booth during all hours of operation: <br /> Lk-Ar r t'}�e1p , C1-',4�� `fitI7, Tim RSISZ <br /> "Important" Al 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 /> thi event_ �} 1 14. Completed by: 6Lu�� t� k17� �1 (4 C r <br /> G'crl' 22 ZG2 Z <br /> (--�Ignature Title Date <br /> 5.10 Gut <br /> Health Permit <br /> D�R Pin line r�.e s <br /> Soso bspers:cr <br /> C�rsq Bart S�v btld <br /> t*aM 8 wow kv <br /> Piopasv Sxiro :;bO <br /> 'g-WV dw. <br /> Booth must be on <br /> Concrete.fuphall <br /> Plywood,or a Tarp <br /> n�rar. <br /> CH7rba <br /> go <br /> Can <br /> Fm EuxscFs:.rxY <br /> Cxtr.+ <br /> w�. <br /> Ice Cooler SCWH.A.s <br /> L.m!n Raps L raxf Cmrta+sen rr.,u o- YrasnrQ Cwsixa <br /> s'svra E rcnes al d the Qrwnd' <br /> 1868 E Haz ellon Avenue I Stockton, Cahfornla 952051 T 209 468-3420 j F 209 464-0138 www sjgov o4ehd <br /> EHn 16-07 Pane a d 11 TE7.W EVEW APP <br /> WI WI) <br />