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Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />13. <br />“Important1* <br />14. <br />I <br />Cvtlriy llovU <br />/ <br />IE <br />IW I <br />f Mm Jt» n*»» 4 / ood Conruvtt rrvti <br />>I<vt4 a nfai oHoil'* grovnil <br />SIkim <br />lOih <br />Wt ll*** im Coot* -IW <br />Garb«go <br />C»n <br />i» u« <br />Kwvl w*kh W*<« <br />Sv»iz«txKkri <br />W»»Oi * Mk< )ur <br />v«uig Clv*.i <br />Booth must bo on <br />Concrete, AjphaH, <br />Hywood.ora Tarp <br />J KOfXZI* lv*> <br />SAN JOAQUIN <br />' • • 'I. \ <br />z <br />Soap and w.,«Hoi* W<Mz <br />'MWi; <br />| Ice Cooler <br />Soap 4ip«At« J -------- <br />"pVVatcr supply dispenser with warm water at a minimum of 100T (i o. 5-20 gallon container with spigot) <br />E J One separate tub (bucket or basin) for the collection of rinse/wastewatcr. <br />Paper towels and pump-stvle soap container. <br />J Hxacn <br />-------- ---- <br />I'atw I <br />I'toparx Siov. <br />[ Health Permit <br />1 a^<Sls O(X,len“a"1' hazard0US '00<,S bCl0W <br />(. 1 Ice chests ^^Refrigerator <br />Refrigerated truck Ice bath and tubs <br /> Other (speafyL.^^ 1=Yl/fa[M 4 <br />^hreeS^^^ 1,6013 ^b'0 my boo,h for ,ho 5ani,ary c,eanin9 of food Reparation utensil <br />dee,p.l(ubs (bas'ns 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 />[ j Tub to store wiping cloths in bleach solution. <br />IwSIf <br />s-“.. <br />boothPf0V,din9 ,he fOllOW’n9 for fldec’ua,e hand washing facilities, but separate from utensil wash within my <br />Names of responsible persons to be present in booth during all hours of operation- <br />__i-Z)t^1 /{ H^t) <br />Ml <br />' /Id <br />................1S"®5®15 <br />d I__J <br />wwwsjgi <br />All food vendor booths are subject to inspection Please make a copy of (his 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 throe weeks prior to <br />this ovony , ll ~ ~ I <br />______zd^Lbs’ Signature Title Date <br />| SM UK I <br />H*>M «*>!> W*t« <br />Completed by.