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SAN JOAQUIN Environmental Health Department <br />10 <br />11. <br />OR <br />12 <br />Paper towels and pump-style soap container. <br />13 <br />•*lmportarit“ <br />lion and operation. Rptyrn/orlglnal <br />Signaturo <br />14. <br />Date <br />Pipe* n kiO Forel J <br />I IlioJChiwidWriw <br />H/o F.VAflmlioz <br />Ice Cooler <br />I <br />PoflO 6 o< 11 <br />I <br />u <br />570 Gal <br />HnndwashWaio' <br />StniUCf bucket- <br />Welch I *-Alc' W <br />nodiip niixio CK*1* <br />Garbago <br />Can <br />Booth must be on <br />Concfdo. Asphalt. <br />Plywood. Of a Tarp <br />| filoidi <br />I <br />Sono n.M Wntoi U,n»o Wjicc 1 | <br />( l»Vd \ <br />WI.IW <br />& Cl»< I <*n<1 V.»1H <br />VMtleirat"' Conl»»X< <br />| Piopew Store <br />;?!W <br />. S I <br />IHOti E | liizclion <br />I t to 10 0? <br />O7/O1/2OM <br />Names of responsible oersons^to be present in boqlh.jfiirin^a^houfs f <br />?_____________—---------—„ . <br />All food vendor boott/s are subject Io 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. Rptyrn/orlqlnal to festival coordinator throe weeks prior to <br />complelBd by. <br />Sjgnaturo Title Date <br />| ivo».».io r*u <br />J Soap <l<«porucc <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[ ] Three compartment sink. <br />1 1 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />L1 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 />J^HA/ater supply dispenser with warm water at a minimum of 100°F (l.e. 5-20 gallon container with spigot). <br />PHJne separate tub (bucket or basin) (or the collection of rinse/wastewater. <br />□ Ice chcZ 'S O Refrigerator <br /> Refrigerated (ruck Ice bath and tubs <br /> Other (specify)..---------------------------------------------------------------------------- <br />| Health Permit <br />Avenue. | Stocklon c^ggmi r rI <br />w’“" <br />Slorno I <br />U.lh | I