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Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e 5-20 gallon container with spigot) <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater <br />0 Paper towels and pump-style soap container <br />13 <br />•‘Important** <br />OwnerCompleted by: 14. <br />Title <br />Health Permit <br />^apef Hand "cweis <br />Soan dispanser <br />Culling 3oars <br />7 <br />BieaenProoa'ie Stove <br />IJ <br />Prooane Tar« <br />Bioac'’ arc Walet <br />F.r« Extinguisnec <br />Ice Cooler <br />46‘1-C i•: j f 2CaMomia :>5 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />extra ice Sags 2 K<xid Conta'iurrs must oe <br />stored 5 rncnes ott of the grour.d' <br />Sierro v/rCharfing <br />0i sh <br />Extra <br />Water <br />5 Gal Hand v/osn <br />7/ane',vntB< Contamet <br />Sanitizer bucket- <br />bieach 4 waler lor <br />storing wiping cloths <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 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 of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation <br />MJ Bermudez. Gefe Roaquin _____________________ <br />•>.20 Gal <br />Hand wash Warer <br />SAN JOAQUIN <br />C o J r-x “ v <br />Garbage <br />Can <br />J0 <br />11/26/2024 <br />Date <br />sigo'-i org/ehd <br />TEMP EVENT APP <br />05 T 2'j <br />“age 8 of 11 <br />1E H?zel:cr <br />DID 16-02 <br />07/01.’2024 <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 Refrigerator <br />0 Refrigerated truck Ice bath and tubs <br /> Other (specify)_ <br />I <br />Soao and Water R>nse fra'er <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 />/ ^(g nature <br />f Booth must be on <br />Concrete. Asphalt. <br />Plywood or a Tarp