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Environmental Health Department <br />11. <br />OH <br />12. <br />[Xl Water supply dispenser with warm water at a minimum of 100"F (i.e. 5-20 gallon container with spigot). <br />S One separate tub (bucket or basin) for the collection of nnse/wastewater. <br />[x] Paper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by:14. <br />Date <br />Health Permit <br />IMpcr Haik! <br />Soar (llwnnsrr <br />Cutting Board <br />Blnac.h <br />Propana Stove <br />LI <br />Bleach him! WaMi <br />Tim ExiinciutsherQ <br />Ice Cooler <br />F1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 I <br />Names of responsible persons to be present in booth during all hours of operation. <br />Romeo and Susan <br />Stnmo w.’GI>.ifiln'i <br />Dish <br />Etlro <br />W.iKrr <br />Gul <br />I land w.ir.h Wnlnr <br />I am providing the following for adequate hand washing facilities, hut separate from utensil wash within my <br />booth: <br />Ico Huas A / o<vi t.iintomoir. nvixt On <br />sfororf « Inchns till «l tlm firounill <br />S Gnl Han<l wash <br />WHStowatnr Contain*' <br />Garbage <br />(;an <br />S.tndi/o’ bu- k'd <br />blrnrh M, for <br />sieving wiping chibs <br />Booth nmsl be on <br />Concrete, Asphalt. <br />Plywood, ot a Tarp <br />Owner <br />Title <br />L <br />Soap nn<1 Writer <br />I r>'Opon« Tank <br />SAN>JOAOUIN <br />------COUNTY------- <br />Greatness grows licce. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous fends below <br />45’F (if food is used the following day, maintain below 41T temperature): <br />E Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <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 he in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior,to <br />this event. <br />Romeo Yraola <br />Signature <br />7 <br />Rinse Watui <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />S Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one foi a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />[Xl Detergent, bleach, and wiping cloths (cleaning towels). <br />S Tub to store wiping cloths in bleach solution. <br />209 464-0138 I www.sraov.o^/ehrt <br />10.