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Environmental Health Department <br />10. <br />11. <br />OR <br />facilities, but separate from utensil wash within my12. <br />14. <br />Health Permit <br />I CmangBMrf [ <br />Prop»rw Stove <br />.. <br />= iil <br />Slamo WCTwffrig <br />Dtoh <br /> <br />ii <br />I ; Ln <br />SanKnctuAM- <br />NMeh&wMwKx <br />McrtigwipinQdoth. <br />[ Soapt^anw <br />lid- <br />B, <br />SJO GM. <br />y Hand wash Water <br />hY <br />11 "-1*" I I <br />x ■■■■■ J--------J <br />I • ■ ii. <br />it'zbsleWfo; l <br />my booth for the sanitary cleaning of food preparation utensil <br />,s!'; <br />vww.sjqov.org/ena ■■dMiii <br />• ( I k_______I <br />hl.; <br />l)^ CT) O(^_______________________ <br />A 1____________S?3 ~~ oo ~^- 'Z- . <br />AB 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 throe weeks prior to <br />Comnl.tod _________ <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />■■■r — <br />CT . ■> ■ ‘ <br />M <br />“^r • / / t. \ ■ i <br />j I l l | dRtmWWr^l' <br />r <br />13. <br />I am providing the following items within <br /> Three compartment sink. <br /> Three deep tubs (basins 6-B inches minimum), one for soapy water, one for rinsing and one for a b <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping doths (cleaning tcwels). <br /> Tub to store wiping doths In bleach solution. <br />I am providing the following for adequate hand washing <br />booth: <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 rinsa/wastewater. <br />| | Raper towels and pump-style soap container. <br />Names of responsible persons to be present In booth during all hours of operation: <br />/y/vxiAel . ................. <br />C^zLoc A l <br />‘‘Important** <br />SANJOAQUIN <br />------COUNTY------- <br />I am providing the following cold temperature control for foe cold bolding of potenbalty hazardous foods below <br />45‘F (if food Is used the following day, maintain below 41 F temperature). <br />Q Ice chests O Refrigerator <br /> Refrigerated buck Ice bath and tubs <br /> Other (specify)-—----------------------------------------