Laserfiche WebLink
9/27/22, 11:53 AM IMG-20220927-WA0000.jpg <br />Environmental Health Department <br />io. <br />ii. <br />for a bleachOR <br />separate from utensil wash within my <br />12. <br />13. <br />'•Important*" <br />Completed by:14.Date <br /> <br />TitleSignature <br />"I P.ipt- : I . <br />r <br />t> t.. .rxi .•..ver <br />California 95205 i T 209 4(S8-34.'u | F 209 464-0138 | www sjgov orq/eh.l <br />3lKi8ElSS’:-_S'.?: « -i i» rriin rww AP" <br />5 ' <br />l^tdc" S .. <br />ilor <>□ »r-j -i ' t <br />Garbage <br />Can <br />Booin inuS'. be on <br />Connete Aspnait. <br />PlywOOC Of 3 ’ 3'P <br />n Ga- <br />Hana '<V3!c‘ <br />\ f’" I <br />I AJW I <br />SW>P <br />_z <br />R .'.w ■•..’> <br />SANJOAQUIN <br />COUNTV <br />•’ C C-romt-.S •••'’■•< <br />I am providing the following cold temperature <br />45°F (if food is used the following day. r.-.c;..*. <br />®<e chests Refrigerator <br />O Refrigerated truck O lce an^ tul?s <br /> Other (specify)— <br />W j % Cc«'.a •- c I <br />I lhK<wor ffw <br />. one for rinsing and one <br />I Health Permd <br />1SWK <br />I am providing the following items within my booth for the sanitary cleaning of food preoaration ulens.l <br />g^Three compartment sink. <br />^Three deep tubs (basins 6-8 inches minimum), one for soapy water, <br />solution (one tablespoon of bleach per gallon of water). <br />[^^gtergent. bleach, and wiping cloths (cleaning towels). <br />[y^fub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but ! <br />booth: <br />■ 3 control for the cold hold.ng of potentially hazardous foods below <br />maintain below 41 'F temperature > <br /> Water supply dispense, with warm water at a minimum of 100'F (re. 5-20 gaflon container wrth spigot). <br />Q<)ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />b/fpaper towels and pump-style soap container <br />Names of responsible persons to be present in booth dunng all hours of operation. <br /> — — --------- <br /> <br />/All food’ve’ndor booths are subject to inspection Please make a copy of th.s application in <br />preparation for this event. A copy of this checklist must be m the bootn at all hours o> <br />preparation and operation. Return original to festival coordinator three weeks prioj^o <br />this event. <br />CuMg toti.-o <br />I ) __ <br />"