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Environmental Health Department <br />10 <br />11 <br />OR <br />12. <br />^0 Water supply dispenser with warm water at a minimum of 100"F (i.e 5-20 gallon container with spigot) <br />E^fone separate tub (bucket or basin) for the collection of rmse/wastewater. <br />(2?Paper towels and pump-style soap container. <br />13. <br />Completed by14. <br />Signature <br />P«p«' I lard T twrts <br />Propana Slow <br />u <br />»m W.COf <br />F «• CiSroaWw <br />Ice Cooler & Gai Hand Md <br />Waatanlar C<nlarwrFifra ka Fa?! i too) Conianen nwv N> <br />ttanj t o” o/ IM ywra/l <br />5-20 Gai <br />IMnilWc* <br />Slf n>o wOu'oj <br />Doh <br />Garbage <br />Can <br />Booth must be on <br />Conaete Asphalt. <br />Plywood, or 8 Tarp <br />Sarmzor tuxXai- <br />UaacTi I ta <br />■tonng wipang ckxr.t <br />SAN JOAQUIN <br />C OUNT V <br />tKpana Tar* <br />Title <br />Names of responsible persons to be present in booth during all hours of operationga/M ZuinUrt/y ___________ <br />c (Th rr — <br />••Important" <br />LL_z <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 /> thiseve?< • - /A//'Z3 <br />Date <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth. <br />| Soo a»a-w | --------\ <br />3U0 <br />lam providing the following Hems wilhm my booth for the sanitary cleaning of food preparation utensil <br />■fj 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 />O Detergent bleach, and wiping cloths (cleaning towels) <br />n Tub to store wiping cloths in bleach solution. <br />LJ <br />So»p »m Wiur <br />1868 E Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www sjcehd com <br />EHD 16-02 Page 8 of 1i IEUP EVENT APP <br />o?/yi7 <br />I am proving the following coki temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 4 IT temperature) <br /> Ice chests -0 Refrigerator <br /> Refngerated truck (ZJ Ice bath and tubs <br />C4 Other (specify) ' _______----------------- -------------------------------------------------- <br />I COknaBMrt I <br />| Health Perm'r'P