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Environmental Health Department <br />11. <br />OR <br />12. <br />S Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Rinse Water Bleach and Water <br />Piro Extinguisher <br />[X] Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Extra fco Bags & Food Containers must be <br />stored 6 Inches off of the ground1 <br />Storno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Waslewater Conloiner <br />Garbage <br />Can <br />Sanitizer bucXet- <br />blcachS water for <br />storing wiping cloths <br />Ice Cooler _____f <br />5-20 Gal. <br />Hand wash Water <br />10. <br />? y ’'-t <br />Soap and Water <br />Propane Tank ' I— <br />L A <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />______________- <br />SAN JOAQUIN <br />------COUNTY------- <br />Greo/ness c/rows Acre. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />■- ■ .. : <br />.____ <br />■ ■ ■ X <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Ernest Nandyal Glory Addanki <br />E 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 /> 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 my <br />booth: 7 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd com <br />oJSiT02 PagoBofU TEMP EVENT APP <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 />■XOUlt/ " <br />A - . ■ <br />' '■ ! U'c' <br />I am | <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />[x] Ice chests Refrigerator <br /> Refrigerated truck 0 Ice bath and tubs <br /> Other (specify)