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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />[X] Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[3 Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />OWNER 06/01/2026Completed by:14. <br />Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />D U 0I <br />Propane Tank <br />Bleach and Water <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off ol the ground! <br />Sterno w/Chaffing <br />Dish <br />A copy of this checklist must be in the booth at all hours of <br />Reti/rn original to festival coordinator three weeks prior to <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />JEAN VALLESTEROS <br />Extra <br />Water <br />SAN JOAQUIN <br />-COUNTY- <br />Greoiness qrows here. <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 />0 Ice chests KI Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />aratipn and I open <br />avent. I I <br />v ] Sipnatur^ <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event, <br />preparation andloparatior. <br />this evegt. I / <br />3 _z <br />Soap and Water <br />E 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />7 <br />Rinse Water <br />z—x Fire Extinguisher