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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater <br />Paper towels and pump-style soap container. <br />13. <br />Completed by:14. <br />Health Permit <br />Papw Hang <br />Soap lispeiYsef <br />Board <br />(Beach <br />Prnoan*: Strife <br />a <br />.K»ari« Tant <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, hut separate from utensil wash within my <br />booth: <br />Slemo WChaffing <br />D>sh <br />iCMUtendmli <br />WMitMBitM Conlmiw <br />5-2C G^. <br />Hand wash Waler <br />SarMmr 0u»«- <br />5 wan for <br />sKnrx; <M(WV$ <br />Inlra <br />Water <br />SAN JOAQUIN <br />COUNTY <br />V? * ''M i <br />Title <br />"Important** <br />Names of responsible persons to be present in booth during all hours of operation: <br />b-k'g-y' C- t-vx <br />I I Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br />Date <br />QJI <br />r-J"""" <br />Extro Ico Bag» « Food Conteiws Mute tw ■ <br />dorod B ncBer odoltho gmmU JJ <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. , 1 / <br />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />0 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 />1 ] Tub to store wiping cloths in bleach solution. <br />,__I <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 0 Refrigerator <br />0 Refrigerated truck 0 Ice bath and tubs <br />0 Other (specify) < x<A <br />CT 2^ <br />Gaibage <br />Can <br />Watw <br />— <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />_______________vMJ <br />1868 P ULo-uJizm A«»aru>^ I •'I'-r/xc* nr'xryr i ^4no i e-