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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Propane Stove Bleach <br />Propane Tank <br />/Bleach and Water <br />Fire Extinqulsher <br />SI <br />EHo^";' :t'"'’"A'/nn"e| CalifonMa 95205 | T 209 468-3420 | F 209464-0138 | wW.Sjgov.Qfgfeh<i <br />07/01/2024 h a9e 8 Of '1 TFMP FVPNT A t07/01/2024 TEMP EVENT APP <br />V U u.L <br />Soap and Water <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water tor <br />storing wiping cloths <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Rinse Water <br />I Extra \ <br />Water <br />Health Permit P <br />**lmportant** <br />Ice Cooler j , <br />SAWOAOUIN <br />-...-co UNITY------ <br />' " ( u 1 t)ro;v-. Ih'tr <br />45T Of food is us^efoltoXg daShte^ P0,ential|y hazardous foods below <br />Ice chests □Refrigerator <br /> Refrigerated tnjck Q lce bath and tubs <br /> Other (specify) <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />a One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[2 Paper towels and pump-style soap container. <br />Names of responsible persons to be^!^”t^°oth d^ng amours, ofoperation: <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 the booth at all hours of <br /> thfewent" ay °peration- Bgtoryiqinal to festival coordinator three weeks prior to <br />_________ <br />Signature .Y Title Date <br /> <br />□ ThPmeVX“WsiXitemS Within mVb°Oth f°r,he Sani^Ptea™9 Preparation utensil <br />Slution (oneV®t8r‘ °ne r'nS'n9 and one for a bleach <br />W Detergent, bleach, and wiping cloths (cleaning towels) <br />LfH Tub to store wiping cloths in bleach solution. <br />I o^hProviding the following for adequate hand washing facilities, but separate from utensil wash within my <br />Cutting Board