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SAN JOAQUIN Environmental Health Department <br />io <br />11 I arr providing ttie following items witnin my bootti toi the sanitary •.leaning of foo-l prepaiation utensil <br />OF: <br />12 <br />^vVater supply dispenser with warm wate; at a m.nimi.rr of WO F <br />One separate tut) (Oiicket or basin) to; tne collection of nnse/wastewater <br />U Paper towels and pumo-stvle soap contaire. <br />13 <br />"Important” <br />Completed by <br />Title <br /> ■ n'il - <br />I <br />r - id ■ <br />1 j uoLs-[i I <br /> ' I <br />£■ i: •WWW .s _n:: Sid <br />r=." Af' <br />1 am providing the following for adequate r.and washing facilities but separate from utensil wasl within try <br />booth <br />Fl'.:;ti must boor <br />Ccncmle Aspr.att <br />I a Tarp <br />W6' E Hareifri ,.;n <br />■JID e Ji' <br />•wn <br />■ < <br />i am pmv.iiing the following cold temperau.’e centra! ter the cola holding o< potentially hazardous foods oelow <br />45:F :if food is used me fr> lowing day maintain below 4 I F ’errperatijrei <br />Ice chests !_| Refrigerator <br />L Refrigerated truck | ~ I ice bath and tubs <br />~J Other (specify/_______________________________________________________________ <br />ir. booth dunng all hours of operation <br />iM i <br />hlVWO'J'j <br />■ •: __________________ ______________ <br />Garbage I <br />Can <br />Signature <br />\ <br />! three deep tubs (basins 6-8 inches minimum) one for soapy water ore tor rinsing and one rot a oleam <br />solution (one tablespoon of bleach per gallon of water; <br />_! Detergent bleach, and wiping cloths l cleaning towels i <br /> I Tub to store wiping cloths in bleach solution <br />— "3Ice Cooler <br />i —-— r <br />i <br />n-’r <br />i e 5-20 gallon container with spigot) <br />T ?C9 'tf.?-342G | F 20 <br />. Tiro eaa-j <br />I Heaim gertr>'t | <br />Names of responsible persons to be present <br />------------ ____________________ <br />All food vendor booths are subject to inspection Please make a ccoy of this application in <br />preparation for this event A copy of this checklist must be m the booth al an hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />this event.