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igna Title Date <br />rice Cooler rj <br />Health Permit <br />fCutoc Board 1 <br />Sterna watnatfiro <br />Oat' <br />Fie Extmgtestier <br />Seep and Water R.nze Water <br />{ &data d:sperls <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />I <br />Paper Hand Towels <br />Sar.:12er terket- <br />terach & water I:, <br />wpin clvhs I Propane $taNns <br />Erna Ice 8a9s & Food CoMemars must ett <br />stored 6 inches cit of The ground, <br />.0 Gal <br />Hand oath Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />SAN JOAQUIN - Environmental Health Department <br /> 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />4F (if food is used the following day,maintain below 41°F temperature): Z(Ice chests Refrigerator <br />Refrigerated truck Edfc'e bath and tubs <br />0 Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />OR <br />131( Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sol2,tion (one tablespoon of bleach per gallon of water). <br />C2 tergent, bleach, and wiping cloths (cleaning towels). <br />ub 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 />Liel<Arater 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 rinse/wastewater. <br />ET Paper towels and pump-style soar) container. <br />Naps of responsible persons to be present in booth during all hours of operation: <br />(1-hA3 IIri-e (wcki )r) <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 />this event. <br />Completed by: <br /> <br />Stc,rk•rin, CIfornii ci5 T 209 468-3420 I F 209 464-0138 I wwwsjgov.orTehd <br />f TEMP EVENT APP ra E AveniiE <br />154, <br />i 9 <br />