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1 <br />Environmental Health Department <br />11. <br />OR <br />12. <br />* <br />13.NMi?hael bfonn16 persons t0 be pr6sent in b00th dur,f19 all hours of operation: <br />14. <br />t <br />Healthpermit <br />Goup-dlsponw <br />Bifiach . <br />SANJOAOUIN <br />-COUNTY^- <br />Qfeatbtuf. tfirowi Here. <br />\ Ice Cooler If <br />Soap and Wsiar <br />| FlraEytlnauHhqr <br />T^'-- <br />Bloaoh and Waler <br />Cutting Board <br />PropaneStove _ <br />Rinse Watar <br />( Bklre \ <br />Water <br />fl Gal Hana wash <br />: Wastewater Container <br />‘‘Important** <br />« ee / <br />atwno w/Chafflng <br />Dish <br />Garbage <br />Can I <br />. :■■ y Extra-lot.8aoi &‘FoodCmtalnon mUUHo <br />" I 3,aiO<f B b}ohes ntf of tl>a ground! <br />I 'Won. CanWaWOS! T | F 209 464.0138 <br />••• <br />- i. <br />10. 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 />0 Ice Shests • Q Refrigerator <br />□'Refrigerated truck Ice bath and tubs <br />Q Other (specitV). .. ......................... .. ...... .................................. <br />lam providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> Three deep tuba (basjns 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 />Alt f°od vendor bMths.aresublact'tQlnspactlon. Please, -make' a copy of .this appiicaliontin <br />prepaSonlnd Xratton be,.ln the bdotH at a" of <br />this event. <br />Completed by: Mishael Moran <br />Signature <br />?Paper Hand Towel*. <br />SonitiwfluGWi. : <br />BdotKmust be on ■ <br />Coficretei.’Asphal^ * i <br />Plywood, or a Tarp; J- <br />” ^-tUrnjpriqlnal to festival coordinator three weeks, prior to <br />----------------------Owner__________ 6/7/2022. <br />Title___________Date- <br />Propane Tank <br />boo7hPrOVld’n9 th® followin9 for adedUate hand washing facilities, but separate from utensil wash within my> <br />0 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.