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SAN JOAOUIN Environmental Health Department <br />w. <br />11. <br />OR <br />12. <br />fxl Water 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 /> Paper towels and pump-style soap container. <br />13. <br />“Important** <br />14.Completed by: <br />Health Permit <br />p.ioof -,an<l rowels <br />Cuttlnq Boerd <br />sPropane Slovn <br />Ju <br />Prouanw Tank <br />Fira Exbnquisher <br />Ice Cooler <br />46‘.-1 i J1dilofi A.'tr 'r) , Sl'JC'.iO'Caiilomia 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 41°F temperature): <br /> Ice chests Q Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />O Other (specify)____________ _— <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 of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Extra lev flngs A EeM Conmnerz must be <br />stomd 6 'echos off ol tho goound! <br />Stemo w/Chaffmq <br />Osh <br />Waler <br />Garbage <br />Can <br />Booth must bo on <br />Concreto, Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />E Three compartment sink. <br />5 Gal Hand wash <br />WaSowalnr Container <br />Sanmaer bucket- <br />btoacb 4 water for <br />storing wiping cloths <br />868 C r‘ <br />EHD IB-02 <br />Ob'19/19 <br />5-20 Gal <br />Hand wash Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />Joseph Spencer — <br />205 I T ?•):-) -188-^-120 <br />Page 8 of 11 <br />Owner/Operator <br />Title <br />12/2/2024 <br />Date <br />J <br />Soap and Water <br />Sepp dispenser <br />_z <br />Rinse Waler <br />Oleach <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 to <br />this event 1 <br />Signature <br />a v/w .sjuov org.' 9h<J <br />'temp EVENT APP