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SAN JOAQUIN Environmental Health Department <br />10. <br />11. <br />OR <br />12 <br />13. <br />’’Important'’ <br />Completed by 14. <br />I Health Permii <br />Pape< Hana <br />Soap dispenser <br />PfOCWit SiUre Biaacn <br />n <br />—S I I Hie txtMHMSUa I <br />and Wahx <br />Ice Cooler <br />868 E Hazelux. /locWhn. CaiiCi <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />Garbage <br />Can <br />Sanazvi aiicMai- <br />uedcr* s niaer 'ex <br />XMMUtg exxn* <br />Boom must be on <br />Concrete Xspnait <br />Plywood, or a Tarp <br />l^llu t FiMl ( > UVM lx, <br />b an ■.>i iav <br />Siemo w/Charting <br />Drsti <br />5-20 Gal <br />Hand wasn Water <br />I <br />Su<*p and Wale I <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 rmse/wastewater ")£. <br />ZZ' Paper towels and pump-style soap container. <br />Title Date <br />G',eotne, <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45t'F (if food is used the following day. maintain below <11 °F temperature): <br /> Ice chests p^Ref operator <br />O Refrigerated truck O Ice bath and tubs <br /> Other (specify) <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<-">^7/7 <br /> <br />Signature <br />( Eu.x \ <br />Waltfi <br /> <br />I ‘J Gji fund froaift J L=: <br />Rm>m$ Water <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 />' ~j 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 />JS. Three compartment sink <br />Names of responsible person^ to be present in booth during all hours of operation <br /> <br />■ T 209 468-3420