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Environmenlal Health Department <br />10 <br />11. <br />OR <br />12 <br />13. <br />Compteled by14 <br />Health Permit <br />Pw»“ Kantf Tcwm <br />(■» 4 <br />fttwr <br />tlM* B>Mt <br />Ice Cooler <br />MecTi & aacn nx <br />*>r*<g WCa <br />GwtxdQ<< <br />Can <br />Cf Water supply dispenser with warm water at a minimum of 100’F (i e 5-20 gaHon container with spigot j <br />[j One separate tub (bucket or basin) for the collection of rinse/wastewater <br />Paper towels and pump-style soap container <br />I am providing the following for adequate hand washing facilities, but separate from utensd wash with<n <br />booth <br />lum mw/i <br />BodhmuM b* nm <br />Ccnctete Asphat <br />Plywood ex a Tarp <br />SAN JOAOUIN <br />r' < 11 n H ‘ <br />I am providing I tic following items within my booth for the samtary cleaning of food prfpo/ator. utem-i <br />□ Three compartment smt <br />tj Three deep tubs (bastis 6-8 inches minimum) one tor soapy water, one tor msmg and one for a bleach <br />solution (one tablespoon of bleach per gaHon of water) <br />EJ Detergent, bleach, and wiping ctolhs (cleaning towels) <br />[3 Tub to store wiping ctolhs in bleach solution <br />••Important" <br />1__, <br />Mint* W«uw | <br />f Mil. \ <br />I XMv I <br />LAx*- I <br />Names of responsible persons to be present in booth during all hours of operation. <br />All food vendor booths are subject to inspection. Please make a copy of this application m <br />preparation for this event. A copy of this checkHsl must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks poor to <br />this event- Li . r <br />______________. __________________?**■'« i < < a. <br />Signature Title Date <br />I ( .,H I .-.H.■ <br />I «" I i •» V <br />I am providing the foBowing cold temperatore control tor ttw* coto br<rtviq of fr. <br />4S’F (it food is used Ihr following day maintain tietow 4I F , <br />□ Ice chests jjjRcfngeratnr <br />El Refrigerated truck D Ice tmth and tubs <br />I”) Other (specify)__________________ ______ <br />I I I »itour^*** j <br />5X1 OX <br />r- Kind <br />I dlWMT^ I — \