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SAN JUAUUIN I iiwii I lo;dih I h p.u ihu.’i d <br />io <br />11. <br />OR <br />12 <br />I ) Water supply dispenser with warm waler at a minimum of 10O' I-’ (i c 5-20 gallon container with spigot) <br />| One separale tub (bucket or basin) for the collection of rinse/waslcwatcr. <br />| Paper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation13 <br />. Chanhmany Sonephomc <br />Completed by.14 <br />Title <br />I I’.npijr Hji» I I UACt1. <br />I Cvlimi lk>.ir.> <br />X. J - J0 <br />h.i>M YVit*» <br />I ‘fr I Vt.fMJVlShCf <br />Ice Cooler <br />C.it f<ur .i <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />I 1 Three compartment sink. <br />I Ke ft i(/\ A I oaii (.’or /.i 5 nu.sf be <br />(• \ the ti’d'ev.}1 <br />b (;.u H.li'rl waJ' <br />r.nr'tunv* <br />C;io <br />Booth must bt: on <br />Concieh! Asplioll. <br />Plywood or <i tarp <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I | 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 cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 4 VT temperature): <br />I | Ice chests [ ) Refrigerator <br />[ | Refrigerated truck [ I Ice bath and tubs <br />f Ollier (specify). N/a .... <br />Sh'rou <br />Dih <br />!> A) ( h H <br />1 I.Kill t. W.lt- * <br />S^n-:zr<li>£ ''.I <br />Prach A > lv' <br />Mama) ai i',! <br />I I la/cltan Avriiuo | '. .tor.kt <br />I III) 16 0? <br />0/(11702-1 <br />-.hl <br />II MP I VI M' API' <br />I lealth Permit J <br />| lui'.-m-.Md ■/.'.i-, i | <br />/ I .:m \ <br />I Walw I <br />I .‘■■I'l -If <br />P.x)- fl o' 11 <br />i "I • I <br />"linportant,‘ 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. / n <br />Stow | » <br />J..c <br />[ S.-ai .nvf | | <br />E3-I