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Environmental Health Department <br />11. <br />OR <br />12. <br />^Papertowafe and pump-styla soap container. <br />13. <br />March 2022 <br />Completed by:14. <br />Date <br />Paper HandTowsU <br />Propane Stove <br />Propene Tar* <br />1 Ice Cooter i <br />TWe <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Slemo urfChaffmfi <br />Di»h <br />S-Gai Hanawaan <br />Wartowatar Cortainar <br />I am <br />45 <br />5-20 Gal. <br />Hand wash WSrtar <br />Saniiizar buckal- <br />tteach & water for <br />storing wiping cloths <br />Can <br />pyxing the following cold temperature control for the cold holding of potentially hazardous foods below <br />(if food is used the following day, maintain below 41 °F temperature): <br />0 Ice chests Refrigerator <br />,CRefrigemted truck nHcebath and tubs <br />O Other (specify) ___________________________________________________________ <br />SAHJOtWIH <br />------COUNTY—- <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth^ <br />(J7fvvater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />,Cfone separate Mb (bucket or basin) for the coitocfion of rinse/wastewater. <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />1868 E. Hazelton Avenue | Stockton, California 95205 ] T 209 468-3420] F 209 464-0138 ( www.sjcehd.com <br />EHD 16-02 Page B at 11 TEMP EVEMT AFP <br />07/3/17 <br />O Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />soMionTone tablespoon of bleach per gallon of water). <br />FT Oetafgant, and. wiping cloths (cteaninfl towels). <br />Lj Tub to. stone wiping cloths tn bteaeh-sokrfioet <br />Names of responsible persons to be present in booth during all hours of operation: <br />(\xX\£<s ’•_____vacuvocX OYA _______________________________ <br />ItAOYWS ftUfrSQ __________________________________ <br />**tmportanC* AH food bboths 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 alt hours of <br />preparafion and aperafiorv-^eCum to weefa pffor to <br />thfoeywrt. /Si <br />v Signature <br />OB' <br />GreaJness grows here. <br />iq. <br />[ Health Permit <br />[ CuttxX Board <br />Bloach <br />. SoapandWmer