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SAN JOAOUIN } iiviroriincni jI I lo.dlli I h.'parfnu.'iil <br />10 <br />11 <br />OR <br />12 <br />13 <br />’‘Important <br />Completed by14 <br />I lealth Permit <br />I'afHH ••.I, ,| | OAC'S <br />nil no il ;.r.| <br />I • ; v r Stove <br />Hmw W.tX *■ I•.«>i .i" l A.ts<So.’l .v’1 A i-r> <br />I .r<* I <br />CO Coo Of <br />»■ <br />Title <br />‘HD K. 0,' <br />'..t ci <br />■^J Water supply dispenser with warm water at a minimum of 100 T (i c 5-20 gallon container with spigot) <br />One separate tub (bucket or basin) for the collection of rinsc/wastcwater <br />Paper towels and pump-style soap container <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <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 "I temperature) <br />I | Ice chests [ | Refrigerator <br />! | Refrigerated truck ( | Ice bath and tubs <br />I Other (specify). <br />On1 H.v'.i a.)M> <br />'.■..is'CAali'r i orH.i ■1 f !s (• li I.J5 X / OOrf('<«l/.l<'Hi»s O’i.sf t'V <br />I (. UKhft o'l o'!' <■ <J'<. >".!• <br />San.Wcf <br />t •each A A.itrr I-..' <br />stor oy a t»ng clc!h$ <br />Booth nmsl tic on <br />Concicle Asphalt <br />Plywood o' a I arp <br />Garbage <br />(}an <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I | Three compartment sink <br />I | Three deep tubs (basins 6-8 inches minimum), one for soapy waler, one (or rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />I Detergent, bleach, and wiping cloths (cleaning towels) <br />I Tub to store wiping cloths in bleach solution <br />. './ifi. 0111 < • <br />II MP I VI Ml API-' <br />/ I *t’.« <br />I Aatvr <br />A, <br />Names of responsible persons to be present in booth during all hours of operation <br />___________________________ <br />All food vendor booths arc 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 fpsjiyal coordinator throe weeks prior to <br />thls.ovont^ ^^5 <br />Signature Title Date <br />b .’0 <;.•«» <br />I M.HI'j Arl'lh W.ttC' <br />’me ■ ! ■lo<:l.|i':i 'ihiv.i . I ?'i‘i •[) i | <br />Page fl of 11 <br />Soap |