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<br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />ater supply dispenser with warm water at a minimum of 10O’F (i.e. 5-20 gallon container with spigot). <br />13. <br />“Important** <br />Completed by? 14. <br />Health Permit <br />Pac* HiAd TowMn <br />Soap dbparmr <br />Cutting Board <br />BleachPropana Stova <br />Propane Tar* <br />Bioach and W«t»r <br />Fra Eumgutsher <br />Ice Cooler <br /> Three deep tubs (basks 6-3 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash wtthm my <br />booth: <br />Extra to* Bags 4 Food Containvt must b« <br />stored 6 tocAes off <V the grounds <br />StecnowChaAng <br />Dish <br />Ertra <br />Water <br />Garbage <br />Can <br />5 Gal H«Ad v>«h <br />Westawater ConUNnx <br />Sanxtet <br />btoech 1 eutaw <w <br />MOrttK) MfOiQ <br />I am prcr/iding the fofiowmg cold temperature control for the cold ho*d«ng of potentiatty hazardous foods below <br />45®F (if food is used the fotowing day, maintain below 41 *F temperature): <br />jzflce chests Q Refrigerator <br /> Refrigerated truck O Ice bath and tubs <br /> Other (specify) ................................ ... <br /> Boom must ba on <br />Concrete, Asphalt. <br />Plywood, cm n Tarp. <br />Title <br />__L <br />Soap and Wot*RtosaWMM <br />5-20 Gal <br />HmdvMhWatM <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensrf <br /> Three compartment sink. — /Vef" <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 />preparation and operation. Return original to festival coordinator three weeks Prior tb <br />this event. / <br /> <br />' /Signature <br />^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />J^^Paper towels and pump-style soap container. <br />Names of responsible oersons to be present in booth during all hours of operation: