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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br />13. <br />Completed by: 14. <br />Signature <br />I <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />it <br />Propane Tank <br />JI Rinse Water <br />F«e Extmqmsher <br />Ice Cooler <br />X <br />I <br />0Three deep tubs (basins 6-3 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 />B'Qetergent, bleach, and wiping cloths (cleaning towels). <br />Etnub 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 />EBice chests Refrigerator <br /> Refrigerated truck EH Ice bath and tubs <br /> Other (specify)_ <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground1 <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 />Stemo w/ChaHmg <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Waslewaier Contams <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 />Garbage <br />Can <br />SAN JOAQUIN <br />C. OU N I Y <br />Title <br />— 7 <br />Soap and Water <br />Date <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[T^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Q/One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />•‘Important** <br />| Health Permit <br />5-20 Gal <br />Hand wash Water