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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />iper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Slgnatu <br />Health Permit <br />Pipw llrnrf T <br />dipwiio.' <br />PraMre 8M«e <br />Profunc Ta'K <br />Q <br />Ice Cooler <br />Silulil <br />(PfvValer supply dispenser with warm water at a minimum of 100’F (I e. 5-20 gallon container wrth spigot). <br />[fl'rfne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />I am proviring the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />O Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />so’uton (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />□^(jb to store wiping cloths in bleach solution. <br />c-Mtn" »Ch*»u <br />S-20 C-t <br />•MM WaJsr <br />5 Gal H»rxi v>a»- <br />.‘isiexiie Ca'Uiw <br />Garlwgc <br />Can <br />&int&6f t'-cKa <br />tMMr taiurfcr <br />pnrtiO vpng ctot'n <br />Bootfi must fcc on <br />Concrete Aftpholl. <br />Plywood, or a Tarp. <br />Date <br />[ FJewS' <br />lanvproviding the following items within my booth for the sanitary cleaning of food preparation utensil <br />S'Three compartment sink. <br />Title <br />J 9a#e*iaM Water <br />I Cxtr' I <br />£»rn) ts t?J9i 4 f ms Ca'titws ctuM M <br />eoraai rrM«i .8 <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 I www sigov.org/ehd <br />EMD 16-02 Paq# 5 of 11 ' TEMP EVENT /»PP <br />oenwrs <br />SAN JOAQUIN <br />------COUNTY------ <br />' G7.’Olnt*»S ijtv.vi. }:t re <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 41*F temperature): <br /> Ice chests ([^Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ___________________________________________________________ <br />Scop aoS Water Rirtx WOar <br />Names of responsible persons to be present in booth during all hours of operation: <br />7 ^>05 mA Alt <br />‘important** 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.