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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />0vWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />**lmportant** <br />Completed by:14. <br /><~Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />v <br />Propane Tank <br />Soap and Water <br />Fire ExtinguisherQ <br />Ice Cooler <br />3 <br />Exira Ice Bags & Food Containers must be <br />stored 6 inches oft of the ground! <br />Stemo w/Chatting <br />Dish <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5 Gal Hand wash <br />Wastewater Container <br />Extra <br />Water <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping doths <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Title <br />5-20 Gal. <br />Hand wash Water <br />SAN JOAQUIN <br />-------COUNTY------ <br />.'"v-i-'' Greatness giows here. <br />I 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 />Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)_—----------------------------------------------- <br />I Rinse Waler <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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />S Tub 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 />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 preparation and operation. Return original to festival coordinator three weeks pnor to <br />this event. —'j" TP x \ <br /> <br />Date