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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Water 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 />Paper towels and pumo-style soao container. <br />13. <br />Completed by: 14. <br />SigjHlfyr^ <br />Health Permit <br />Stemo w/Chaffing Dish <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />i0°I <br />Propane Tank <br />Rinse Water Bleach and Water Garbage Can <br />Ice Cooler <br />1 <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 />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 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 <br />Ice bath and tubsRefrigerated truck <br />Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I <br />Fire Extinguisher / <br />Soap and Water <br />0 uv1 <br />Title <br />/6> -a-/7 <br />Date <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />------- <br />Extra Ice Bags & Food Containers must be <br />| stored 6 taches off of the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />SANJOAOUIN <br />------COUNTY------ <br />' Greatness grows here. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_______E- /—-c-C_____~ ____________________________________________ <br />_______"7~«> - Q CU .A eT________________________________________ <br />‘‘Important** ^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. /C-. / ~