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e.pn.q <br />SAN JOAQUIN lealth DepartmEnvironment□ <br />10. <br />11. <br />OR <br />12. <br />! One separate tub 'bucket or basin) for the cotlection of rinse/wastewater. <br />13. <br />“Important** <br />Completed by.14. <br />bl <br />JI <br />I WVAV <br />Fr» E.1OV- K- I <br />'>?0 <br />HqnrJ *j»h rtuir <br />Garoagi- <br />Can <br />•' | T 209 468-3420 | F 209 464-0 <br />Psge >’ •” 1 <br />Bootti mus’ be c.- > <br />Co:k. t>(e A-spnui! <br />Plywood or a Tarp <br />.. . <br />.z»W ;.4' <br />I am providing the following items within my booth for the sanitary cleaning of food preparation jtensi) <br />{] ’>i'ee compartment sink. <br />’ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleat <br />solution vone tablespoon of bleach per gallon of water). <br />Deta: gent, breach and wiping cloths (cleaning towels). <br />' Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash witf m my <br />booth: <br />fv^VVatei supply dispenser with warm water at a minimum of 100‘F (i.e. 5-20 gallon container with soigct <br />riMPEviNT a»-.- <br />I am providing the following cold tentperaturS control for the cold holding of potentially hazardous foods below <br />45°F (if food Is used the following day. maintain below 4TF ternporature): <br />□ Ice chests [y1 Refrigerator <br />Refrigerated truck | 1 |eQ oath and tubs <br />□ Other (specify) <br />Ice Cooler..._____> <br />Q Paner towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation <br />■' (__6 c<(CC('C\f i Lu ftr J - <br />AlHood vendoTboothEare subject to Inspection. Please make a copy of this application m <br />preparation for this event. A copy of this checklist must bo in the booth at aK hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />o^r <br />v sj^nature Title Date <br />| Som diocnxt j , ■ . .. ' <br />W68 e Aven» !95 <br />-