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SAN J UA Q U I N F•!e,-1!#:!-1 De?PM11TWIt'tt <br /> 10. 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 followingday, 8lntain below 41°F temperature): <br /> E]Ice chests efrigerator <br /> ❑ Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11. l�mp�roviding the following Items within my booth for the sanitary cleaning of food preparation utensil <br /> Rathree compartment sink. <br /> OR <br /> 0 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 /> 12. 1 am providing the following for adequate hand washing facillties, but separate from utensil wash within my <br /> booth: <br /> rater supply dispenser with warm water at a minimum of 100eF(Le,5-20 gallon container with spigot). <br /> Wn"a separate tub(bucket or basin)for the:collection of rinsetwastewater. <br /> L-LJ-Paper towels andu�rrtp-style soap container. <br /> 13. Namesof ansible per to be present In booth during all ours o peration: <br /> r <br /> "Im ortant*,' /41:3crod vendor bootlis 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. Rghirn orf fnai to festival coordi ator three weeks prior to <br /> this event. <br /> 14. Completed by;_ CWK N ^ C; <br /> Sign' Title Dato I <br /> Health Permit IWd Wash Wma <br /> MON <br /> Slvr[w wlChWlusp _ <br /> -•----�- I'a�l ! <br /> $Dep WepPMv/ <br /> Cusbnp Elders Sealtcvr 6uckoSl <br /> Gcarh 8 water Wt <br /> Propene Slvvv nsdncn e�M vrieln0�OLnJ <br /> Cpoa€h nlus€ba an <br /> oncrete•ltsp11811. <br /> Plyvrcad,ora T. <br /> PraMnv TenX — T 11r <br /> Soap vnd Wa;4r ltUrcv 45'aler lllvach ani�Walvr I Garbage <br /> Fire F:tinpreslsor Can <br /> C ` <br /> E:>flru <br /> Waim <br /> Ice Cooler oae„mmlwes€, <br /> 1:rlrQ roendg=�, <br /> dQlncn <br /> f <br /> IF3G3 E I l;lzultan nvcrnrii' .tr�s;kt1>rl. Cr.l6fulrnu f)i?{l:l l T 2Oft 4638-3'1,�f1 I 1{7i€,t€i4 tl 1 ii wewr s c av(}lg14.1]d <br /> r' f <br /> Fsln}iG•02 Page 8 0111 17IEMI°EVEN V APP <br /> O7Po 17262A <br /> 2 <br /> l <br />