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Environmental Health Department <br />y <br />10. <br />11. <br />OR <br />12. <br />S Waler supply dispenser with warm water at a minimum of 10CT (l.e. 5-20 gallon container with spigot; <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />E Paper towels and pump-sty|e soap container <br />13. <br />Important** <br />OwnerCompleted by: 14.DateTitleSignature <br />]Pnpo' Hand ro*»'« <br />Soap <br />«<<i »cf> <br />1 lUajch end WnWr <br />FUo ExVnaulll'.or <br />znllnr A , .StocKlon California 9r'Z05 ■ <br />I am providing the following Items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth; <br />5 Gil Har.d Mib <br />/<3<IVWOt»' ConUlno' <br />t-IO O«l <br />Hand wath Wa<M <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />3ui.no wfChDttVtp <br />01 Hl <br />3»rttaor boduM- <br />Novc/l k kbIot lor <br />•0x1 no wWnp ctotht <br />r 209 -6^ .1'120' F 209/!6'J 0138 wwiA-.sjaov nigrehc <br />; l| TPV • c VI: \ ' Al-c <br />oropano Tmik I <br />Soap anrfWo-.ee <br />Names of responsible persons to be present in booth during all hours of operation: <br />Susan anc riorz-r; > ~d.;!2 _________________ <br />\ — <br />‘■•1/ <br />SAN.JOAQUIN <br />• fe; ------COUNTY— <br />Greofnpss growt here. <br />I am providing the following cold temperature control for the cold noKling r,t potentially hazardous fooos i viow <br />45T (If food Is used the following day, maintain bwlow 4TF temperature; <br />(3 Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tuba <br /> Other (specify)------------------------------------------------------- ---------------------------------------——------------------------- <br />| Health Permit p <br />i Ice Cooler I <br />i V <br />I CuWao Omid | <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 bo In the booth at all hours oi <br />preparation and operation. Return original to festival coordinator three wooks prior to <br />this event. ,, , <br />■ - - 1 z n ■ _-* <br />I Ropano Slovo <br />RlmaWaigf <br />El Three deep tubs (basine 6-6 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 />S Detergent, bleach, and wiping cloths (cleaning towels). <br />S Tub to store wiping cloths In bleach solution. <br />tDifro ttO 4 Fudif Conrerrera nvji< ts |H <br />4?< ml •ncJior ytr zfiho