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10/08/2018 22:46 2093335599 04/11LASPAGE <br />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 /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0.Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Pepsr HandTowelj <br />Soap d lap an 8 er <br />Culling Board <br />Propane Stove <br />43 <br />Fine ExtlngulshGTs <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Conlelner <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />8iemo w/Chaffhg <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer buckef- <br /> bleach & water for <br />storing wiping cloths <br />Names of responsible persons to be present in booth during all hours of operation: <br />SANJOAOUIN <br />------COUNTY------ <br />Greatness grows kere. <br />Title <br />Soap and Water <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 events , <br />d RAR F- Mpviiltari Awaniia <br />Received Time C.'.. : i T <br />07/3/1 7 <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 4TF temperature): <br />Ice chests 0 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />0 Other (specify)___ _________________________ ____________________ <br />‘"'Important** <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 />0 Three compartment sink. <br />---------------mJIce Cooler iW <br />Propene Tank <br />I <br />Rinse V/a(er Bleach and Water <br />EX/ra fce Sags & Food Containers must be ■ <br />stored 6 Incnas off of the ground! ' H <br />... I QtTLf7p 95205 I T 209 468-3420 1 F 209 464-0138 | www.sjcehd.comOct. 9. 2018 1 0:24AM No. 4246 pagesofn TEMP EVENT APP <br />Date