Laserfiche WebLink
Environmental Health Department <br />10 <br />11 <br />OR for rinsing and one for a bleach <br />12 <br />13 <br />'•Important" <br />Completed by14. <br />Health Permit <br />Paper Hand Towels <br />CuiwxjBGa'd <br />Bleach <br />P'ccane Stcrve <br />n <br />Bieacn ana WaterSoap and Water <br />X- <br />Fire Extnqursher0 <br />Ice Cooler <br />TEMP EVENT APP1868 E Hazelton Avenue I Stockton <br />EHD 16-02 <br />06/19/19 <br />Stemo w/Chaffrrg <br />Daft <br />Extra <br />Wa’er <br />5 Gai Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sandier b jd<et- <br />bieacn A water for <br />storing wiping Cloths <br />5-20 Ga! <br />Hand wash Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink <br />----------------------- <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarpr2 <br />Rinse Water <br />r»fra /ce B»gs t focd Containers must be <br />Uorea 6 mcbes ol 0/ IM g'Duna1 <br />r)\V <br />Title <br />p-cr>*n» ran* <br />SAN JOAQUIN <br />COUNTY <br />Greafneu growl here. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />AST (if food is used the following day, maintain below 41 °F temperature) <br />Tj^lce chests -fiRefrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)------------------------------------------------------------ ------------------------------------------------------------- -— <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water) <br />Detergent, bleach, and wiping cloths (cleaning towels) <br />SfTub to store wiping cloths in bleach solution <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />'I^Water supply dispenser with warm water at a minimum of 100°F (i e 5-20 gallon container with spigot) <br />Rl One separate tub (bucket or basin) for the collection of nnse/waslewater <br />t^sPaper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation <br />_____Miytko-— ------------------------------ <br />I Soap o>spen$er <br />Cahforma 95205 | T 209 468-3420 | F 209 464-0138 | www sjgov org/ehd <br />Page 8 of 11 temp event ai <br />If 1 I [I <br />All food vendor booths are subject to inspection Please make a copy of,this> apphcation 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 pnorjo <br />this event. < n - ____ <br />/S^gnatu/e