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i SAN JOAQUIN Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />5-20 gallon container with spigot). <br />13 <br />'‘Important” <br />Completed by14. <br />Date <br />*i.io kioor'.** <br />3lUU< I' <br />•‘’•nOuru <br />T <br />i*fi:o*wk> ' »'ii <br />Ice Cooler <br />i <br />F_MP EVENT APPP KJ" t <br />-------------------------1 <br />Health Permit j <br />l <br />I <br />• *0 l'j-02 <br />Booth must bo on <br /> Concrcto Asphalt. <br />Plywood, or a Tarp <br />Sti.rrv w/CI'.«ir>nr| <br />PI'UI <br />•i •i.il'MiMJ <br />'ft Htiiwih.f <br />Garbage <br />Can <br />Water supply dispenser with warm water at a minimum of 100 'F (i.e <br />One separate tub (bucket or basin) for the collection of nnse/wastewater <br />Paper towels and oump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation: <br />Kishawn Bennett ______— <br />i.rui'ir Wjw* <br />ui.urn 4 «wr iiw <br />4unnq '.Mwrq 'loth'* <br />J <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 4T’F temperature): <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />Other (specify) Not serving cold food ____________________ <br />fw.' V >■ trxl 'ft.ih.r | <br />| C'li.i •] l«;.i ■< I n.i p/ <br />j <->••/« <Wir. ■<1 <br />I am providing the following items within my booth for (he sanitary cleaning of food preparation utensil <br /> Three compartment sink. <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 cf water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />M Tub 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 />AH 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 m the booth at all hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />thia-ay£QLKishaWn Bennett Owner Nov 28th, 2024 <br />Signature <br />Owner I <br />Title <br />".ir.l .».| .n ft.Mcr <br />X