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E,J I U i € �llFJI� t�9q , l 9~lir.^1.s`iy da o`r't. +}CSt7L'4}�d�f:. <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45"F(if food is used the follotrring day,maintain below 41'F temperature): <br /> UN Ice chests ❑Refrigerator <br /> (]Refrigerated truck ❑Ice bath and tubs <br /> ! ®Other(specify) -- -._ -- <br /> 11. I am providing the following items within my hooth for the sanitary cleaning of food preparation utensil <br /> []Three compartment sink. <br /> OR <br /> ❑ Three deep tubs (basins 6-8 inches minimum), ona for soapy water, one for rinsing and alie for a bleach <br /> :solution(one lablespoon of bleach per gallon of water). <br /> ❑DGtergent,bleach,and wiping cloths(cleaning towels). <br /> ❑Tub to Slow wiping cloths in bleach solution. <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate fron3 utensil wash within Iny <br /> booth: <br /> A Water supply dispenser with warm water at a minimum of 100aF(i.e.5-20 gallon container with spigot). <br /> M One separate tuts(bucket or basin)for the collection of rinseAvastewater. <br /> ❑Paper towels and punt st a o�p container. <br /> 13. Names of responsible persons to be present in booth during all houm of operation: <br /> "Iropoitantr' 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 ordinator three woksrrp •or to <br /> this event. <br /> 14. Completed by. Al i _res <br /> Signature Title Date <br /> 5.26 Gal <br /> Health Permit I no lm10wash WBFrr <br /> stertia'Cl+aling---�__ <br /> U PJPBr 1i�nJ Twwls <br /> Saab dispcns.r <br /> Car;tkfn A.ra nt 5anroznr UueJeok- <br /> 61r3[h 8 water for <br /> slorkyj%%&11 enthc <br /> —Proparu Slava Wcudr <br /> Bootle must be on <br /> concrete,Asphalt. <br /> r1tywond,nr a Tarp. <br /> - <br /> IS SwpandMW irnscai:r Blaarh7n wDler Garbage <br /> i � earl <br /> FlrcExtirlgarsha <br /> I-arm <br /> Ice Cooler s"•t'T 5GalNaad +sh <br /> F3 !ce Hags P.Fuad Llwlravrars rslusr IMr Wastevraler Gordalnar <br /> - slo,ed 61nchw oflarthe ground? <br /> 1869 F. Hazalfen Avenue ( Stockman. California 95205 T 209 468-342.0 j F 209 4.94-0138 v.,vw.sjgov.oralehd <br /> Eldn 16-12. Paye 8 or 11 TEPA'EVF-►ar APP <br /> Qn119119 <br />