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Environmental Health Deoartmen; <br />11. <br />OR <br />12. <br />Q Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />Completed by: 14.TitleSignati <br />Health Permit <br />1 Paper Hand Towels <br />JCutting Board 3Propane Stove <br />n z <br />Propane T ank <br />3I;Fee Exunouisher <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5 Gal Hand was* <br />■Aas'-ewaier Convener <br />Garbage <br />Can <br />Stemo w/ChalTrng <br />Dish <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp- <br />5-20 Gal <br />Hand wash Water <br />Sammer bucket- <br />bleach & water lot <br />ilonng wtprng cloths <br />—JL <br />Soap and Water <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 />I Bleach <br />V.-- ' ■ - . • • • ■ :: <br />i <br />£«Jre m Baps 4 Food Containers mutt ba 3 <br />snn0 6 nchat off ot tba gmundi ■ <br />Avenue | Stockton. California 95205 I T 209 468-34201 F 209 4644)>38 I <br />ttlMi 164)2 Page 8 ot 11 <br />rMriWiti <br />Na^p-pso^! <br />Soap dispenser <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Q Three compartment sink. <br />^jfi-One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />l^Paper towels and pump-style soap container. <br />of responsible persons to be present in booth dunng all hours of operation <br />-ky/ _____ _____________ <br />**lmportant** <br />z3E3rU ui <br />r \ <br />_L____ <br />Rinse Water I Bleach .tnd Waler <br />R <br />SANTAQUIN <br />-----COUNT>------ / . t <br />A tree;..... s [ <br />10. lam providing the following rcold temperature control for the cold holding of potentially hazardous foods below <br />CCCaRsD v45°F (if fobd is ubed’th'e following day, maintain below 41°F temperature): <br />3. Ice chests Refrigerator <br /> Refrigerated truck bath and tubs <br /> Other (specify), <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 priorAQ <br />Invent