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Environmental Health Department <br />10. <br />Food Tr uck <br />11. <br />OR <br />12. <br /> Waler supply dispenser with warm waler al a minimum ol 100°F (i.o. 5-20 gallon container with spigol). <br /> One separate tub {bucket or basin) for lhe collection of rinse/waslewater. <br /> Paper towels and pump-style soap container. <br />13. <br />'‘Important’* <br />14.Completed by: <br />Popcr Hand Toivels <br />CUffiJi fJonxi <br />□leachPir.'pnrH) S'o.'i! <br />Piopanc Tank <br />Wuil'.-lHiiitHVnlUt <br />firn E.lin,bi ilnai <br />Ice Cooler I I <br />.............. <br />D Three deep tubs (basins 6-8 inches minimum), one for soapy water, one lor rinsing and one lor a bleach <br />solution (one lablesiwn ol bleach per gallon of waler). <br />O Detergent, bleach, and wiping cloths (cleaning towels). <br />I I Tub Io store wiping cloths in bleach solution. <br />I am providing the following lor adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing lhe following items within my booth lor lhe sanitary cleaning of food preparation utensil <br />Three comparlrnont sink. <br />Garbage <br />Can <br />Sami nr Uu’kel- <br />bleach <br />slodny vdplnjj c'otlr. <br />S'emow Chalfnij <br />Oisli <br />L.lia <br />v/wer <br />5-20 CUI. <br />Hand wash Waler <br />OOiillhindvzjMi <br />WaamMW Conuhiar <br />iy:-<r-f- <br />Filrn 1 /> rby :,? ronrlCnnhiitem hiii-il tin j. <br />laoicrj 6 iiXhM ntl <>t tho OiomJI <br />I Soap d.cpmuui <br />I <br />Sc.H|>wi>JWiii<-r <br />I <br />SAN JOAQUIN <br />......COUNT Y- <br />. , . G; f<‘ :;iu •• . <br />I am providing the following cold temperature control for lhe cold holding of potentially hazardous foods below <br />45°F (if food is used lhe following day, main lain below 41 ®F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated buck Ice bath and tubs <br />/ ...FoodTruckM Other (specify)_______________________________________________________________________ <br />1868 F, I lazolton Avonue | Stockton, California 95205 | T 209 468 3420 | F 209 464 0138 | www.sigov.org/chd <br />EHO IG 02 PngoantH TEMP I-VEN I API' <br />0S‘10.'19 <br />1Z-U <br />/ <br />H n»> Wiilef <br />Blrakta iVa^O’Amliraj'Sai'tam ^Slrman? PoKel <’Nis3ia|l Ihapa01 0,;)era'ion: <br />Health Pormil T <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation lor this event. A copy of this checklisl must be in the booth at all hours of <br />preparation and operation. Return original to testlval coordinator three weeks prlpr to <br />Sig nature ' Tit Io bate <br />Booth filllGl bo on <br />Concroin, Asphalt. <br />Y—Plywood, or a Tarp.