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4 <br />SAN JOAQUIN i De <br />w <br />11 <br />OR <br />12 <br />water at a minimum of 100°F (i.e 5-20 gallon container with spigot) <br />3 One separate tub (bucket or basin) for the collection of rinse, wastewater <br />13. <br />“Important <br />Completed by14 <br />; Health Permit ' <br />r <br />and W3!«Hlc <br />Extra <br />I <br />F .;i,.vr.y <br />Garbage <br />Can <br />Booth must be on <br />Concrete Asphalt <br />Plywood or a Tarp <br />/c* 4 <br />'c <br />EMach & wow 'c? <br />wptnfl rjcws <br />SutfAG W'ChlsHrng <br />D»«h <br />sigt?-. org/eM <br />TEIUP EVENT *PP <br />Names of responsible persons to be present in booth during all hours or gpt <br />Wrvr-AV extvX <br />3 Paper towels and pump-style soap container <br />be present in booth during all hours of pperabon <br />[/^Water supply dispenser with warm <br />I am providing the following items within my booth for the sanitary cleaning of food preparation uten.sii <br />LJ Three compartment sink <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 />K] Detergent, bleach, and wiping cloths (cleaning towels) <br />Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash withii m, <br />booth <br />T 201 <br />Pag« S of 11 <br />'r <br />Rm£« WjtMM <br />Title <br />'a> <br />% <br />“•Jl <br />r <br />c <br />All food vendor booths are subject to inspection Please make a copy of this application <br />preparation for this event <br />preparation and operation <br />this event . L iV KytACic V I <br />Signature <br />% <br />I <br />|.| . I'l <br />ice Cooler <br />i m <br />A copy of this checklist must be n the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />Date <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods beiow <br />45' F (if food is used the following day. maintain below 41 F temperature) <br />'Jjfi Ice chests Refrigerator <br />O Refrigerated truck EJ Ice bath and tubs <br />□ Other (Specify)... . <br />H_I3 <br />t <br />I