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� l 0 ( ( � Environmental Health Department <br /> �I �--- <br /> ��5 f)reatness grows here. <br /> 10, 1 am providing the following cokl temperature oontrol for the cold holding of potentially haZMdus fOW$ balow <br /> 45°F(if food is used the foilowing day,maintain below 4VF temperature),. <br /> ❑ loo chests 1-1 Rofrlgarator <br /> ❑Refrigerated truck El Ica bath and tubs <br /> 11, t am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> El Tbrae deep tubs (basins 6-0 Incheas minimum), one for soapy water, one for rinsing and vire 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 solutlon. <br /> 12, l am providing the following for adequate hand washing facllities, but separate from utensil wash within my <br /> booth: <br /> E WMtor supply dispenser with warns water at a ntinlmum of 100°F(Le,5.20 galfon oonta)nar with spigot)- <br /> r-1 ono separate tub(bucket or basin)for tate calleotfon of rinaefwastowater. <br /> ❑Paper towels and pump=sty1a 8n=container, <br /> 13. Names of responsible persons to be present in booth during all hours of operation,. <br /> "Important*" All fond vendor booths are subject to inspection. Please make n copy of this appllcaNan in <br /> preparation for this event. A copy of this checklW must be In the booth at all hours of <br /> preparation and operation. BelMm orl;Llklal0 fosflypl coordinator Uwe Zjoks prior to <br /> this even <br /> 14_ Completed by: az --- 6w"- u � <br /> Signature Title nate <br /> Health PermlE a orar <br /> Esiftw %FQ <br /> fs�h Piper H�ri fwsds <br /> Oasp dkp�� <br /> �� hl�anh A+,nt�r lar <br /> rtiageM slog <br /> B1rndK�'0�^9 tlotlr <br /> Booth must be on <br /> Corimle,Aaphplt, <br /> s�Sywo�d,or a Tarp, <br /> Avpwm T"' <br /> Soap rd Walk Rhee We41r E3MllDt7 nnC Yl�br �8f9 <br /> Can <br /> rl1 EW OuMw <br /> Cukr <br /> Wkal <br /> lce Cooler aOaiNandNO'^ <br /> F*"to e*p a rxwd corkw,"MW be w..ww K.rr�,t,Fe <br /> trnvf d a Whd-i 6W" <br /> 1888 E. Hazelton Avenue l StoWori, California 9,9206) T 209 456-3420 j F 209 464-0138 1 www,$)gov.org/et)d <br /> EHD 10-x2 PRgt 6 of 17 TVMP EVENT ANP <br /> 0710fMA <br />