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& M ? <br />Environmental Health Department <br />10 <br />11. <br />OR <br />12 my <br />13. <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Tc*ei» <br />Soap d ipenter <br />Cut: hq Bo.i'd J B'cachP-epa-e St».e <br />Ta'k <br />B each and vyaier <br />f<rc EitinguiSher <br />S’crno *'Cnaff.ng <br />D.sn <br />5 Cai Hand wash <br />Waste* a'er ContainerErtrj /'<. Cjjj t Foca Ccntjnvrs must bo I <br />Oc-J 4 ircrici c-'f c* fne gmund1 (j <br />Garbage <br />Can <br />SarmerbuOM- <br />tteacb i water for <br />stonng wp-nq cWh* <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <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 />L^Kjce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />ith during all hours of operation <br />/lutnV A ________________ <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 />5 70 Cai <br />HivMfwMhVMtaf <br />Ice Cooler • <br />_____V <br />Names of responsible persons to be present in bootl <br />Ca4'LyS,/' \J.P\7y7.Qr <br />“Important** A” <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />M 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 />M 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 <br />booth: <br />^fwater supply dispenser with warm water at a minimum of 1 GOT (i e. 5-20 gallon container with spigot) <br />[^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />C^ Paper towels and pump-style soap container. <br />Soap and Water Rmw Water <br />E>tra <br />V/ater