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bHLN : UlNCfc LHKbtN HH1NI1NU L HlICfcC <br />Environmental Health Department <br />■? <br />10. <br />11. <br />OR <br />12. <br />le soap container. <br />13. <br />"Important** <br />Completed by. 14. <br />Health Permit <br />Paper Hand Towtrt <br />Soap dsapwcer <br />Btoecti <br />I ptcparNtar* <br />Fire Extinguisher <br />5-20 GaL <br />Harxi wash VAnr <br />Stamo urfChaffing <br />Dish <br />5 Gol Hand whsTi <br />VUbsccunaer Contain or <br />(garbage <br />Can <br />©^aper towels and pum <br />Names of responsible persons to be present in booth during all hours of operation. <br />Sanitizer budwt- <br />DKnch&wstartor <br />amrinQ wiping cwna <br />supply dispenser with warm water at a minimum of 100T (Le. 5-20 gallon container with spigot) <br />S*0ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Title <br />x. <br />& if <br />-j.’— <br />'-"r |t <br />O5, »-1 <br />Ice Cooler <br />EXTiB icvHass Kf^ioaComioersmusiOo <br />Moreo e aiches otfpf (tie ijraartf <br />SAN. JOAQUIN <br />------COUNTY------- <br />C'cc-ness gro'-vs <br />chests {^"Refrigerator <br />0 Refrigerated truck O Ice bath and tubs <br />□ Other (specify)___________________—----------- —---------------— " <br />I amproviding the following tens within my booth for the sanitary cleaning of food preparation utensil <br />[Tffhree compartment sink. <br />Sebree deep tubs (basins 6^ 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 />0^etergent, bleach, and wiping cloths (cleaning towels). <br />B^Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I I Bleach aid 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 ooerjatioix?Return original to festival coordinator three weeks prior to <br />this event, v <br />Date <br />---------------------- <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp. <br />_____________/ <br />Jan. lb ^Ulb Ub^f'HMbHX NU. : 4bbb4b4 <br />SoapsndWiKw Rinse Wafer <br />CuUina Board | <br />Praparn StOvO <br />4