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SAN JOAQUIN Environmental Health Department <br />10. <br />OR <br />12 <br />Paper towels and p-stvte soap container. <br />13. <br />’’Important’* <br />14.Completed by: <br />Date <br />Health Permit ■ <br />Sow dupenw <br />BojrC <br />J I <br />Ice Cooler La <br />•Tu <br />LL <br />Rj.-ui AuMm <br />Title <br />Slwnoo^ChalUig <br />CM <br />5-1'0 <br />tU'.x: obVi <br />OartMoe <br />Can 7 <br />1 am providing the foi’owing cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41"F temperature): <br />V? Ice chests Q Refrigerator <br />LJ Refrigerated truck Q Ice bath and tubs <br /> Other (specify). i ..4k.-'? \ — <br />I am prowl <br /> Three compartment sink <br />s to bq present in booth during all hours of operation <br />igi_________________________ <br />w Cewwnw <br /> iMWC* « W«M» for <br />ttc^O^xjdWlS <br />d <br />yl 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 />p Detergent, bfeach, and wiping ctoths (cleaning towels). <br />S' 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 />Water supply dispenser with warm water at a minimum of 100’F (i e 5-20 gallon container with spigot) <br />IS One separate tub (bucket or basin) for the collection of rinse/wastewater <br />ling the following dems within my booth for the sanitary cleaning of food preparation utensil <br />Al< 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 aJ hours of <br />preparation and operation. Return original to festival coordinator three weeks pri<?r to <br /> <br />Signature <br />Names of responsible persons to be { <br />_____\J A <br /> L UauK*. aritf -ftMef <br />EHDU-OZonovagiN <br />r hw.-d <>52051 T 209 468-3420 | F 209 464-0138 | www $ <br />Puga 4 <411 <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Ta/p <br />VifiUf