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6 0 11/ <br />Dat Title <br />Health Permit <br />Soap ctspanaer <br />Fee Exrnoutsher <br />Fexa <br />Water <br /> <br />Ice Cooler j <br /> <br />Extra ite Begs & Food Containers must be <br />armed 6 mama off Oe round, <br /> <br />Corn; Boort <br />Propane SCOW. <br />Stamp wiehaffing <br />Dm. <br />5-23 Gal <br />Herd wash 'Nate- <br />Paper Hand Towels <br />Sanibzer <br />bleach & water to, <br />SIOleg Among doe's <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />5 Ca! Rend woe, <br />WaVewster Cordaro, <br />I Garbage <br />Can <br />SAN JOAQUIN <br />—COUNTY-- <br />Environmental Health Department <br />' <br />1 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 />c(I-ce chests rr'Refrigerator <br />Refrigerated truck D Ice bath and tubs <br />CI Other (specify) <br />lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />EZ"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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution. <br />12 I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />,1271ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />12/One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />2'Paper towels and pump-style soao container. <br />13. Names of respossibles persons to be present in booth during all. hours of operation: <br />1-Z.)17i C. cf- VN/W (-17>COr hel‘Nevl ir‘ t Lt .r.S? C•ri.7 <br />OR <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 this eve <br />.ho'v <br />Signature <br />"important" <br />14. Completed by: 'T • (-). k