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I <br />SAN JOAQUIN Environmental Health Department <br />10. <br />11 <br />OR <br />12 <br /> One separate tub (bucket or basin) for the collection of nnse/waslewater. <br />I <br />13 <br />“Important** <br />14.Completed by. <br />Signature <br />Health Permit <br /> PacvMBnaToMh <br />Ice Cooler <br /> u <br />SanMstuM <br />tMK*a wavks <br />Mwiy <br />5 G*> •t*'1 <br /> I <br />l <br />II <br />I <br />I am providing the following cold temperature control for the cold holding ol potentially 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 truck Q lce and ,ubs <br /> Other (speafy) <br />S2GG* <br />Handwmf. Wmb <br />Gartiage <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm waler at a minimum of 100eF (i.e. 5-20 gallon container with spigot). <br />BooV> must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarpr <br />j <br />Suw. ml <ftac <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 /> <br /> <br />Title Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />[^kThree compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for nnsmg 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 />ri <br />Hnw W«Mr f RajK-r «ar <br />R <br />1868 E Hazelion Avenue | Slockion California 95205 j T 209 468-3420 | F 2U9 464-0138 | v,-ww Sjgov org-eh.! <br />EHD 16-rt? IfcMPfVEVl <br />07<th 7024 <br />■■ <br />£rtz» kv I bacD CoMatnm mnt br <br />4 lnct»n of Of »X froan«> <br />^5 Paper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation <br />LiSfo ______-_________ <br />Sb