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Environmental Health Department <br />10. <br />11. <br />OR <br />12. <br />13. <br />Owner 05/31/2614.Completed by: <br />Title Date <br />Health Permit <br />Paper Hans Tow*. <br />Soap dispenjcf <br />Blc-acrPropane S:o/o <br />% <br />Propane Tank <br />F«o EalmqushorG <br />Ice Cooler <br />I CKOnC I T OHO 4fiO.Q4OA I C OAQ /ICrl.nnD IkJT’rJlrxr* Awaci1DCQ cr %tna/ta« c»i <br />Eitra <br />Water <br />H 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 />H Detergent, bleach, and wiping ctoths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Storno w/CbaWng <br />OsP <br />5 GM Hand wa«n <br />WKMKtr Contamor <br />5-20 Gal <br />Hand wash Water <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Garbage <br />Can <br />Names of responsible persons to be present in booth during all hours of operation: <br />Fadeem Abdul <br />ss grows here. <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 />(ZJ Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) <br />S»niuz<x buckos- <br />4 wa-.ei lex <br />stonng wiptng cfoths <br />SAN JOAQUIN <br />------COUNTY------ <br />Great <br />_z <br />Soap and Wat« <br />IL_Z <br />Rinse Water <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 />r <br />Signature <br />'^V/ater supply dispenser with warm water at a minimum of 100'F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^Paper towels and pump-style soap container. <br />•’Important** <br />I les Bags i Food Contamars muS be I <br />I stored 6 inches off of ths ■