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Date Signature <br />this event. <br />C <br />Title <br />14, Completed by: <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 oriainal to festival coordinator three weeks prior to <br />••• •••04.1. • • • • " ••• • •••• • • ON e• I <br />Health Permit <br />5-20 Gal <br />Hand wash Watef <br />Paper Hand Tow', <br />Sterno woChaerng <br />(Nsh <br />Cuaang Board <br />Propane Stowe <br />I Soap &sperms <br />Smatter bucket- <br />bleach & water trof <br />stonng wpng <br />Garbage <br />Can <br />Soap and Water Rune Water <br />Edra boa Bags & Food Conforms musf be <br />stores! d etched off al the ground' <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />VI,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 rinse/wastewater. <br />VI Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />lq t1A4k 3 it1141 1)Ai1cAltS <br />SAN,JOAQUIN <br /> <br />Environmental Health Department <br />co U NT <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 />Ice chests 1;0 Refrigerator <br />0 Refrigerated truck D Ice bath and tubs <br />12 Other (specify) <br />am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />OR <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). D Tub to store wiping doths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: