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Environmental Health Department <br />10. <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 />Q One separate tub (bucket or basin) for the collection of nnse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. <br />•‘Important' <br />14.Completed by: <br />Signature <br />Paper H«nd Towels <br />Propane Sioro <br />BtoKti and WalerRinse WaterSoap and Waler <br />Fee Eatrnguaner <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Q 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 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. Return original to festival coordinator three weeks prior to <br />this event. <br />5 64 Hand wav> <br />Wadowaiar ContanM <br />Stomo w'Ct’offing <br />OWt <br />Garbage <br />Can <br />San<i20« txxikot- <br />bte.sc* 4 water tor <br />rtonng wiping ctotns <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />G••. '.‘.’.i..1 •.’1_____________________________________________________________________________ ____________________________________ <br />| Propane Tank <br />I <br />I Soap drspcnsor <br />I Cutting Board <br />6. 1/2026 <br />Date <br />| Health Permit | <br />WO Gai <br />r- Hand wash Water <br />ow$ he <br />----------------------------------------] <br />Erfra Ice Saga 4 Food Contanen muar 6e ■ <br />0Dr*d 6 mcnes off of me gnxxM' | <br />Qanny I imas <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness <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 /> Refrigerated truck Ice bath and tubs <br />Q Other (specify)_ S<»lf Cnnfmnnd Itnlinn Irp Cart <br />Owner_______ <br />Title