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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />□‘Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Cjf One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14.Completed by: <br />Signature Date <br />Health Permit <br />Paper Hand Towels <br />Propane Stove <br />it <br />Propane Tank <br />EUeacti and Water <br />Fire ExtinquishorQ <br />Ice Cooler <br />1RRR P HaTpItnn Avpm ip I Stnnktnn C.alifnrnis I T 7HQ 4.RR-342n I F OnOdRA-HIRR I \mxmxm cinnv nrn/phd <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 />□Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/Chaff<ng <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Donald Jiminez <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 eveflXT ___ <br />Sanitizer bucket­ <br />bleach & water tor <br />storing wiping cloths <br />( Extra ’ <br />Water <br />.Owner <br />Title <br />Bleach <br />I Extra lor Hags & Food Containers must be I <br />stored 6 inches off ot tho gmundl | <br />z <br />Soap and Water <br />_z <br />Rinse Water <br />I Soap dispenser <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <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°F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />5-20 Gal. <br />r- Hand wash Water <br />h\