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EnvironmOtal Health Department««• <br />10. <br />11. <br />OR <br />12. <br />Q Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. <br />14. <br />Date <br />Health Permit <br />Paper Hand <br />Soao dBDvwer <br />CUdna Ecnard 3 rPropam Stava <br />Steach ar»d WafisrRinw Water <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />fee Sags & Focrf jTsrat ba <br />staflMP indies affcftfrG grcw<*f <br />Exlm <br />Wafer <br />5 Gal Hand watsn <br />7r*5te«atsr Cantarw <br />Garbage <br />Can <br />Saniizcr OiKkal- <br />bleach S. wass/ tor <br />Uannq wltlnq dclhs <br />Booih must be an <br />Concrete. Asphalt <br />Plywood, or a Tarr <br />I am providing the foltowing for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5.20 Gai. <br />Hand wash Water <br />Ice Cooler <br />Jk <br />•'Important** j <br /> jOcxJ <br />Ssama M^Chatrng <br />□ISTi <br />I <br />I Soap and Water <br />E-doxJsrcr <br />SANJOAQftN <br />— COUNTV—- <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 4TF temperature): <br /> Ice chests O Refrigerator <br /> Refrigerated truck Q Ice bath and tubs <br /> Other (specify)..................... ............. <br />Fraoanfi I ank <br />——---—A <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth dunng all hours of operation: <br />rVbxMwsjv Czcyv) o • 4gsy___________________ <br />CZoA) ~ ^327 <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 /> <br />Title <br />this event <br />Completed by: <br />j Signature