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SAN JOAQUIN I iiwii OfiHir.'n'nl l lOidlh iiiH.-ni <br />I am providing the following cold temperature control for the cold hoklmg of potentially hazardous foods below10 <br />n/a <br />11 <br />OH <br />12 <br />I* | Water supply dispenser with warm water at a minimum of 100T (i e 5-20 gallon container with spigot) <br />b(| One separate tub (bucket or basin) for the collection of rinse/wastcwatcr. <br />lx I Paper towels and pump-style soap container <br />13. <br />“Important' <br />14 <br />Date <br />Hjhi lc*<is <br />I <br />I uin,* I in <br />RaiM ‘A'lh f <br />I <br />loo Cooler <br />Sh'ii’o w'CW'ing <br />Olh <br />!> (>al II.11W wn-Ji <br />■A.iMcAKtcr Cont.ime' <br />Sumtizer tnir.kvt <br />tilc.Kh A *alc> k" <br />slM dobs <br />Booth must De 01’ <br />Concrete Asplinlt. <br />Plywood or n I <irp <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 />[ I 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 />1 <br />I III) 16 0? <br />OZ'C 1/2024 <br />Giifbiigc <br />Can <br />.11 <br />I I 111,I \ <br />I Watet <br />rl. J JoLol. <br />[ CultKMillo/inr <br />45'T (if food is used the following day, maintain below 41T temperature): <br />I ) Ice chests I I Refrigerator <br />[ | Refrigerated truck [ I lee bath and tubs <br />[ | Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />( ] Three compartment sink <br />Names of responsible persons to be present in booth during all hours of operation: <br />Lesley Hellef <br />| Sortn fli’pcmcf <br />All food vendor booths arc 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 />“7°^- „ 2/27/25completed by:. . Lesley Heller <br />Signature <br />J IHc.k i> <br />_Pres___ _ ___ <br />Title <br />S 20 <>» <br />■i.»d mrAabz <br />I •hj Ice (1.191 X I oo<l Co-il.i'Hezs /"..M Uv <br />6 nKhei nil <br />| lloii.nif Stove <br />11111 <br />I !.!/( Hoti Avenue | !aocMen C.il Imma Pb':)!- . I P"*) dm*, p.-i "j • I 2./1. wwv. ‘.|qmz < • 1 <br />P.igc <1 ti( 11 ’I MP I VI N /.I’M <br />| Health Permit <br />, I „ / <br />S3;.|1 .ml 'A'.'tiv <br />I .re I