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SAN JOAQUIN Environmental Health Department <br />10 <br />11 I <br />OR <br />12 <br />L_, Water supply d sperser w.t‘i warm water at a minimum of 100 F (I e 5-20 ga’lor container witn sp goti <br />Li One separate tub (bucket or basin) fo' the col ection of rmse/wastewater <br /> Paper towels arc pump style soap container <br />!13 <br />‘•Important” <br />this event. <br />Completed by 14 <br />tt <br />)L <br />fe ll I • c. <br /><— <br />f <br />■■ •.’> I VF V A <br />J <br />I <br />r > i- -. • i! <br />I am p-ovidmg the following cold temperature contro ter the cod hold ng cf potent a ly hazardous foods below <br />45 F (f food is used the following day ma nta n beow 4‘! F temperature) <br /> Ice cnests [J Refrigerator <br />L , Refrigerated truck Ice bath and tubs <br />Q Other (specify) <br />I am p'evid ng tne fo lowing for adequate hand washing facilities but separate from utens I wash with n my <br />booth <br />Garbage <br />Ca- <br />Booth nust be cn <br />Concrete Aspnat <br />Plywood o' a ’arpX <br />j <br />iu_Z <br />u <br />Ice Cooler <br />, Three deep tubs (basins 6-8 inches minimum) one for soapy water, one for rinsng and ore ‘or a bleacn <br />solution (one tablespoon o‘ bleach per gallon o' water) <br /> Detergent bleach and wpirg cloths (cleaning towels) <br />Tub to stere wiping cloths in b'each solution <br /> j S >: C• •••.- <br />Names of respons ble pe'sons to be present in booth during ail hours of operat or <br /> C i1 f> | S- ■,( h r ■ fl fl ___________________ <br />Lam pi o’, d ng the fol owing items within my booth for the san tary clean ng of food preparat on utensil <br /> Three compartment sink <br />L1 <br />A'.l food vendor booths are subject to inspection Please make a copy of this applicator in <br />preparat on fo' this event A copy of this checklist must be in the booth at a bojrs of <br />preparat:on and operation Return original to festival coordinator three weeks prior to <br />________ ___________11 <br />--Signature Title Date <br />[ Hea th Permit