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Environmental Health Department <br />I <J| ... <br />10. <br />11. <br />OR <br />12. <br />^[^Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14.Completed by: <br />Signature Title Date <br />f’npor I kind Towels <br />Soon dispenser <br />Cutting Hoard <br />liloachI’ropano Slovo <br />'' ' < <br />f'ropano lank <br />Rinse Water Hlcnch rind Water <br />I ire I xtin<|iiishcr <br />I Ice Cooler <br />IWiHF I laznllnn Avnnim I Stnrklnn Cnlifr-imi.'i I T 700 I I- 700 ztH/UirW I wia/w cinnv nrn/nhrl <br />^fWater 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />this event. <br />5 Gal I land wash <br />Wasltiwnlor Conlalnor <br />Sanitizer bucko! • <br />bleadi 4 water for <br />storing tuping doll's <br />Booth must ho on <br />Concroto, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gul. <br />I kind wash Water <br />Storoo w/Clialling <br />Dish <br />Garbage <br />Can <br />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 /> Ice chests Refrigerator /\Z4?- <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) ______________________________ ______ ______________ <br />SANJOAQUIN <br />COU NfY <br />Lxha Ico Bogs 41'ood Contahms misl bo <br />stored 6 fric/ios off of IIio gtoutKl! <br />Health Permit <br />_z <br />Soap nnd Writer <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br /> Three deep tubs (basins 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 />Names of responsible persons to be present in booth during all hours of operation: