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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />"Important** <br />Completed by:14.Signature <br />Health Permit P^etHand Towels <br />CuBing Board <br />Bleach <br />Propane SKwe <br />Fie Extinguisher <br />Ice Cooler <br />ISSSSSel <br />Stemo ^Chaffing <br />Dish <br />SGaIHmdwmh <br />VtaMvCoiMW <br />5-20 Gai. <br />Hand vtosh Water <br />preparation and operation. <br />this event. <br />i SaeriEerbudrat- <br />llh n->-«■— <br />waring wmgddhe <br />f------------ ' ' <br />Booth must be o» <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Title <br />Rinse Witer I <br />fi <br />mSL JS <br />SoapdspensM <br />Z5 <br />Garbage <br />Can <br />... .jBaaaw,..;..... , <br />SANJOAQUIN <br />------COUNTY <br />Greotoess grows here, <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 />5Q Ice chests ^5.Refrigerator <br />Refrigerated truck Ice bath and tubs <br /> Other (specify)------------------------------------------------- ------------------------------------------------------------------------------ <br />BtaachandW^r | j <br />jceospa 3 Food <br />— <br />rawater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[D One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br />Prlnvid rv\.<\CxciS---------------------------- ------------------------------- <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 />nrpnaration and operation. Return original to festival coordinator three weeks pnor to <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />yl 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />.u’Ht <br />Bl <br />SaapandVWter