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SAN lOAOHIN I nviroinnr.'iihil llo;illli ii/i'.'iii <br />10 <br />11 <br />OH for finiin'j nnd ono /'x :> bleach <br />12 <br />O One separate tub (bucket or basin) for lhe collection of ringe/y/astev/ater. <br />••Important** <br />Completed by: 14. <br />Signature <br />Health Permit <br />p/UZ-j <br />ir-'-j/Ji <br />r*-' <br />I <br />fee Cooler <br />n w’i v» in ah1I'/vy; fi d 11 <br />&Glf lf.vdW»V> <br />(ZrXM-zr <br />Garbage <br />Can <br />U«V>1 ft <br />06-71 <br />Ikxrfh mull to cn Ccnvcif;, Mphall. <br />F’lyv/ood. or a far? <br />fUtrro <br />If-Vt <br />•^Vi M <br />HM'i utUl'flM <br />Date <br />U<.V> //»*' <br />(O <br />P*p4rH<iM toofit ] <br />6 <br />Title <br />I am providing the following Items v/ltliin my booth for Ilia sanitary cleaning of food preparation uforiftd <br />f/J Three compartment sink. <br /> Paper tov/cls and pumP/AtylQJW;’P container. <br />13 Hames of responsible persons to be present in booth during all hours of operation. <br /> Three deep tuba (baalna 0-8 inchco minimum), one for noapy water, one <br />solution (one tablespoon of bleach per gallon of waler) <br />(>} Detergent, bleach, arid wiping cloths (cleaning towels) <br />Tub to store v/iping cloths In bleach solution. <br />I am providing the follov/ing for adequate hand washing facilities, but separate from utensil v/ash •//ithin m/ <br />booth: <br />^fWaler supply dispenser with v/arrn water at a minimum of WOT (i c. 5-20 gallon container wilh spigot) <br />I nrn providing lhe following cold Icmprirnluro conlrol for lhe cold lioldirig of polonliail/ ha/ardci-. fo'/Jc r/:<w <br />45T (if food is lifted the follov/ing day, maintain holo?/ 4 rf Imnperafuro) <br />| Jlccchcftts M Hofrignrator <br /> Hefrigemted truck I ) lee hnlli and tubs <br />fl Other (specify)____ ____________ <br />Hames of responsible persons to be present in nootn curing an noum oi up«jiriuu>>. <br />JVlr^/- 5-A?/_______________________________________________________________ <br />All food vendor booths are subject to Inspection. Please make a copy of this application in <br />preparation for this event. 7\ copy of Uiis checklist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator throe weeks pnorJ.Q <br />this event. <br />/ till M O vjl i 14-z/ !■<> I <br />trmt: Ih/offoriAvemml htocklon Cahfumia | I 209 4(18 :M20 | I 21)9 404 OIJU | vw.v sjrjuv org't ■..) <br />rrior^w r'/v/jSt/n rtMpnvHiTAi <br />ci//oi/;wx