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Ln v i ron i no n ta III oa it h De pa ill n en I <br />10 <br />11. <br />OK <br />12 <br />| >| Waler supply dispenser with warm water at a minimum of 100T (i e 5-20 gallon container with spigot) <br />| .'I One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[ hPaper towels and pump-style soap container. <br />13 <br />“Important** <br />owner14. <br />Date <br />Slerou wzChaN ni: <br />Ice Cooler <br />| k 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 />[ ) Tub to store wiping cloths in bleach solution. <br />I <br />I <br />I <br />* *.>kT •ui <br />Mo'hm; mprij <br />Booth must be on <br />Goncjctn Aspha I. <br />I’lywootl. or a 1 arp <br />Names of responsible persons to be present in booth during all hours of operation: <br />Brian Cluistic/Eric Berry ____________ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />!> Ci.ll H.WW1 <br />(.’ui I.m-h* <br />Garbage <br />Can <br />SAN JOAQUIN <br />■ • ■ I. • <br />| I'.opone InnK <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 4 IT temperature) <br />I Ice chests I Refrigerator <br />| Refrigerated truck [ ) Ice bath and tubs <br />) Other (specify)__ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[ ] Three compartment sink. <br />Steve <br />| Cutvio fjoant <br />I <h.i kv n.iqs * I ootl Co'itMicn (><• <br />ill'ted 6 oic'icj vtl V the yMiJ1 <br />IIM8I Haze ton Avemiv I Skx hto') tJalrlomia | I 20‘J 4(hJ 342U I I 20-I4G10I38 *.|gov ory/ehd <br />I I ID 16-02 Page 8 Olli It'MP !Vf NI API' <br />06/19/’0 <br />I’.iixj I land I ends | <br /> <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 (tie booth al all hours of <br />preparation and operation. Rcturiypriginal to festival coordinator throe weeks prior to <br />thia event. X) V <br />Completed by:. ...... <br />' SignafttrtT Title <br />| Health Permit |llatul wash WMu< <br />Kuisc Wale.