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Environmental Health Department <br />Greatness grows <br />10. <br />11. <br />OR <br />12.my <br />13. <br />14.Completed by: <br />Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cuttinp Board <br />Propane Stove Bleach <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Waler <br />4/25/11 <br />Date <br />Soap and Water <br />"Important** <br />1 J6?' Conla/ner, musl <br />stand 6 inches offofthe ground! <br />« HaZel'°n Aven‘,e I California 952051 T 209 468-3420| F 209 464-0138 | www sj90V 0^®TAPR <br />(W1W19 Page 8 of 11 TEMPEvtNi <br />SAN JOAQUIN <br />■COUNTY— <br />Greatness 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 />^llce chests Refrigerator <br />Q Refrigerated truck S-lce bath and tubs <br /> Other (specify)____ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />booth: <br />^£3 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />tzTOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation- <br />"Important** 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 />4. Wen. <br />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />J^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 />Wpetergent, bleach, and wiping cloths (cleaning towels). <br />'H'Tub to store wiping cloths in bleach solution.