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SAN JOAQUIN Environmental Health Department <br />lu. <br />11. <br />OR <br />12. <br /> Paper towels and pump-style soap container. <br />13. <br />"Important** <br />Completed by: 14. <br />VHealth Permit <br />Soar disr.en*.« <br />31-tarti <br />u <br />HI •:.></> and Walw <br />r.»ca <br />LIce Cooler <br />1 <br />j <br />y_ <br />ocUn <br />fc« Boas 4 Cmui c j'-t.i hvit m..sr i» <br />■Vari’tJ 6 n^oj :'1 'jl '*•<’ j-'JAau’ <br />Gal Hana wav <br />W.IS'.ffW.ltef c<x-ta ref <br />Garbage <br />Can <br />S.V't fr buii-.l- <br />bliW. A wa'.nr ■<•• <br />»:u‘,U* tz' uiUl- ■> <br />r«ta <br />Aaln <br />5-20 Gal. <br />-.aid w.isn .Vahx <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a ’arp. <br />sumo w/Oatting <br />I <br />ehd co- ' <br />TtMP EVENT AP'- <br />O Water supply dispenser with warm water at a minimum of 1 GOT (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater.,^, / 7^"' <br />E] Refrigerator <br />/ / /E] Ice bath and tubs <br />----------- <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 41CF temperature): <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />I '63 C I laznl,ri A. !•» <br />EHD 16-02 <br />073'17 <br />stocks :■ Califon a 95205 T 209 468-34 20 I F 209 461-0 ’.?? <br />Pagn 8 of 11 <br />Title <br />Names of responsible persons to be present in booth during all hours of operation <br />TT)? l.rh{ (‘- It t'y______________________________________ <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 />preparation and operation Return original to festival coordinator three weeks prior to <br />this event, <br />Signature <br />it/I <br />M nui W.itn- <br />l:4M' 1OWVQ <br />I am providing the following items within rm- booth for the sanitary cleaning of food preparation utensil <br />[J Three compartment sink. / , //--A' <br /> 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 />EJ 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 />Dati