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SAN JOAQUIN I iiviroimieiifal Health DcpaHi <br />10 <br />11 <br />OR <br />lor aonpy wnler, ono lor riming and ona lor a blench <br />12 <br />|X1 Water supply dispenser with warm waler al a minimum of 100 I (i e 5-20 gallon container with spigot) <br />| /J One separate tub (bucket or basin) for Hie < olleclion of nnso/waslewaler <br />[Z] Paper towels !>yl pump style soap < onlainr.?i <br />13 <br />••Important*' <br />ICornplelfi'l by <br />I leallh Permit /. c i i'i <br />I' -I <br />Ili.r,- Coolni <br />’(’■) -1i-l mail | <br />O-M > ' <br />Title <br />I am providing the following for adequate hand washing facilities, bul separate from ulcnsil wash within m/ <br />booth <br />I am providing the lollowmg items within my booth for the sanitary cleaning of food preparation utensil <br />I ] Three compartment sink <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />451 (if food is used the following day, mainlain below 41’1 lomporature) <br />[yl Ice chests I | Refrigerator <br />I 1 Refrigerated truck | | Ico bath and tubs <br />[J Olhoi (specify)______________ ____________________________________ _____________________________ ____ <br />vCub.ujf <br />Can <br />WWW H/gtiv nig < lid <br />ii Mr i vi Ni <br />Date <br />I'., WjI. <br />Hoolli iiuisl I .• on <br />Ccm trie .A -.1'11.111 <br />Plywood i'i i 1 a.p <br />Names of responsible persons Io Ire present in booth during all hours of operation <br />En CCll m r \ ____________________________________ <br />I time deep tubs (basins B H inches minimum) ono I <br />solution (one tablespoon ol blear h per gallon ol waler) <br />[X] Detergent bleach, and wiping cloths (cleaning towel'.) <br />[/} Iub to store wiping cloths in bleach solution <br />15 E3BE3110 <br />| ! • if. |. <~i | <br />/ I .1.1 <br />I V.'itcl <br />| | I ........... .1 <br />IH’d I II . lloi, AVt lltm | .'.In- I Inn I '. ,lifni 11 1 1 •'>.'I I'. | I .’I I' I -|l >M . i-1 |)| | <br />| III) II. 0? I 1J-. Dull I <br />ii j’/ol/ <br />All food vendor booths am subject Io inspection Please make a copy of this application m <br />preparation lor tins event A copy ol this checklist must be in the booth at all hours of <br />preparation and operation Return original to Icstlval coordinator three weeks prior to <br />this event. / ,7 / <br />____ <br />Signature