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SAN JOAQUIN Environmental Health Department <br />w <br />12 utensil wash within my <br />13 <br />“Important” <br />14 Completed Dy <br />Signature <br />Health Permit <br />'i<l «»< dt <br />- <br />I ...... <br />i »;irhnun <br />Ice Cooler <br />1868 r Hazeitoii A /euue <br />• It • -. Al ^->,19 e** <br />>n< tteo *«**,</ <br />•• • .j» »h * M' <br />Booth ’imr.l bo on <br />Cr»nrrn<»' An|ih.ilf <br />r’lywoo'l. nr a 1 Arp <br />‘.n'»i -1i.r».r fuii <br />lib Mr II 1 ‘4* I1»»l f <br />•I’ Hit *9 Mlftll t| ■ I'flh <br />■ <br />Names of responsible persons to bo present in booth during all hours of operation <br />-----------------------------Tam Tran—_____ <br />ft- <br />I am providing the following for adequate hand washing facilities, but separate from <br />booth <br />\^Water supply dispenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot). <br /> One separate tub <bucket or basin) for the collection of rmse/wastewater <br /> Paper towels and pump-style soap container <br />toi.kton < anform.i c>52(>'» , T 2(>'i 468 ,UZ() F ,'O'i 464 D 1 | www-,|i|ov anpMiiJ <br />t>MV< S -V 11 Tt:A«» f;Vt M i AIT* <br />'1 A£>PrOvid,n9 the following items within my booth for the sanitary cleaning of food preparation utensil <br />I JfThree compartment sink <br />OR <br />, i hree 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 />O Detergent, bleach, and wiping cloths (cleaning towels.) <br />lJ Tub to store wiping cloths in bleach solution <br />.I Paow- Murwl I'«»«Ar <br />All food vendor booths are subject to inspection Please make a copy of this application »n <br />preparation for this event A copy of this checklist must be in the booth al all hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />Owner 4/2S/2025 <br />Title Date <br />' a7.Pro’;,d,n9 the ’o'lowing cold temperature control for the cold holding of potentially hazardous foods below <br />4j F (if food IS used (lie following da^ maintain below 41 F temperature): <br />t j Ice chests fjSLpcfrigeralor <br />I Refrigerated truck LJ Ice bath and tubs <br /> Other (specify)