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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />□ Paper towels and pump-style soap container. <br />13. <br />'’Important** <br />Completed by:14. <br />Signature <br />Health Permit <br />Swap 11>5OW>VT <br />Propane Stove <br />Propane Tank <br />Ruue Water £We.i^ □n.JWelreSoap end Water <br />ii-. <br />Steino w/Qtafling <br />Dish <br />______Li <br />Ice Cooler ft <br />** ■ -i 1 >M l*T <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />"t^Waler 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 />^^m^providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />O ^hree 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 />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. ~ <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 ctiecklist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />c . ____ _ z" <br />r * * • H-s • • <br />1865 E. Hazelton Avenue f StockUm/Calcfomla 9,5205 } T -209 489*3420.')■* <br />•’ l ■ <br />krrc.V4'' <br />I am <br />_45 F (if food is used the following day, maintain below 41 °F temperature): <br />□ Refrigerator <br />□ Ice bath and tubs <br />08 org/efi J <br />itmp E.vrt;' -pp <br />........... <br />Narr^s of responsibleperspns to be present in booth during all hours of operation <br />% SANJOAOUIN <br />------COUNTY------- <br />Greotness grows here. <br />providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />□ Ice chests <br />'^^Refrigerated truck <br />□ Other (specify) <br />Title <br />HanaTcwrvi* <br />$an.tuw <br />A tur <br />tWrinj nicinj dctea <br />Baotr. must be on <br />Concrete. Asphalt. <br />Ph/wvoo. or a Tarp- <br />Hw>d wh '.V.liw <br />Culling Board