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SAN JOAQUIN Environmental Health Department <br />'O <br />11 <br />OR <br />•2 <br />13 <br />••Importanf <br />Completed by1.*. <br />Heal'? Permit <br />/ <br />fl <br />Ice Cooler <br />/if IKfl If - • <br />•r/.'l' F ,( NT <br />I | <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />. ] Three compartment sink <br />• ••'j *«•/ lU'j ■ <br />rti/rd f, / •. <br />Garbagi' <br />Can <br />U <;V. n uil O-' <br />Cuncreie <br />Pi/wooc o’ a ’an1 <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water one for rinsing and one for a blearh <br />iqljtion ione tablespoon of bleach per gallon of water) <br />Detergent, b each and wiping cloths (cleaning towels) <br />iXl t ib to store wiping cloths in pleach solution <br />l am providing the following for adequate hand washing facilities, but separate- from utensil wash witnu <br />booth <br />Please make a copy of this application -n <br />A copy of this checklist must be in the booth at al hours of <br />Return original to festival coordinator three weeks prior to <br />~7//#/63 <br />Date <br />All food vendor booths are subject to inspection <br />preparation for this event <br />preparation and operation <br />this event. . <br />•j~>a I <br />Signature <br />'bbij L Ha.’elton/'vnur i Sic.'-lor <br />• HO 1602 <br />I am providing trie following cold temperature control fo' the cold holding ot potentially tiaza- Jous \ods t • >,•, <br />tS'F i t food is used the following day maintain below 41 F temperature) <br />L^lce chests Refrigerator <br />Refr gerated truck £] Ice bath and tubs <br />□ Other (Specify) <br />Title <br />I <br />Water supply dispenser with warm water al a minimum of 100 F (i e 5-20 gallon container wit' spigot <br />^^One separate tub (bucket or basin) for the collection ot rinse/wastewatei <br />>5^ Paper towels ana purnp styie soap container <br />Names of responsible persons to be present in booth during all hours of operation