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Environmental Health Department <br />10. <br />11 <br />OR for soapy water, one for rinsing and one for a bleach <br />12 <br />K) Paper towels and pump-style soap container <br />13. <br />**lm portant** <br />14.Completed by: <br />Paper Hand Tpaveii <br />Soap di»pense>1 <br />Bleach <br />Qi 5 <br />Propane Tank <br />Attnavit aiVrilnvi- <br />EH0^Ha2eitonAVenlJe| S'^lon. California 95205 I T 209 468-34201 F 209 464-0138 I <br />07/3/17 Page 8 of 1107/3/17 <br />fee Cooter <br />Hea.iih Permit <br />Eitra Ice Bass < food Contamen must be <br />Uomd 6 Incbea oHoftha grounOl <br />Stemo w/ChaffoQ <br />Dish <br />5-20 Gal <br />Hand wash Water <br />Cartage <br />Can <br />www sjcehd com <br />TEMP EVENT APP <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Water supply dispenser with warm water at a minimum of 100°F (i e 5-20 gallon container with spigot) <br />rX One separate tub (bucket or basin) for the collection of nnse/wastewater. <br />5 Gel Hand wash <br />Wastowatar Contamur <br />Sanitizer txicket- <br />txeacn & waler tex <br />skxmo wiping cloths <br />SAN JOAQUIN <br />-----COUNTV------- <br />operation Return original to» festival coordinator three weeks prior to <br />9-/3-/^ <br />Date <br />C lv/v t X- <br />Title <br />_z_, <br />Aliw IlWr |l X arW ilMer U <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink <br />[5^ Three deep tubs (basins 6-8 inches minimum), one <br />Solution (one tablespoon of bleach per gallon of water) <br />S Detergent, bleach, and wiping cloths (cleaning towels) <br />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 />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. Retui <br />this event i' <br />/ Signat^Ve <br />Cuang Board <br />I Propan* Stove I <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day. maintain below 41 F temperature). <br /> ice chests â–¡Refrigerator <br />â–¡ Refrigerated truck lce batt1 and tubs I <br /> Other (specify) ___________________________________ ______________________________ <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br />F.«V» <br />Watar