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Environmental Health Department <br />10.I am providing the following cold temperature control for the cold holding of potentially hazardous foods oeio'/ <br />11. <br />OR <br />12. <br />O Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />this event. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />3 c <br />Propane Tank <br />Soap and Waler,Rinse Water Bleach and Water <br />Fire Extinguisher <br />“tce-Couter^ <br />5-20 Gai. <br />Hand wash Waler <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />EJ^aper towels and pump-style soap container. <br />Exira Ice Bags & Food Containers must be <br />stored 6 incbes off of the ground! <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping doths <br />Stem© w/Chaffing <br />Dish <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 />^-Srtjhature Date h <br />45°F (if food is used the following day, maintain below 41 °F temperatures <br />O Ice chests D Refrigerator <br />I—I Refrigerated truck Bice bath and tubs <br />Q Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />B Three compartment sink. <br />C] Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />SQltrtion (one tablespoon of bleach per gallon of water). <br />Q^Oetergent, 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 within my <br />booth: <br />SAN JOAQUIN <br />COUNTY <br />Greatness grow1 lierc <br />' ....- "0 <br />- - - -A <br />5 i . i • Uu ' ■ -