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SAN JU- QUINI Env�rcnmenta� HeaKh Department <br /> 10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45':"food is used the following day, maintain below 41'F temperature): <br /> ce chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my ooth ^for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink./� W e YZ /V Lxq" 14 <br /> OR <br /> ❑ 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 facilities, but separate from utensil wash within my <br /> booth: <br /> EJ-W-ater supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> [26ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Erl5a­per towels and pump-style soap container. <br /> 13. Names f responsible persons to be present in booth during all hours of operation: <br /> rK� 6�I GiZ IZE A YL+r V,ire�-- <br /> **Important** 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 coordinator three weeks prior to <br /> this eevveenntt. <br /> 14. Completed by: L G..3 <br /> Signature Title Da <br /> 6-20 Gal. <br /> Health Permit Ste Hand wash Water <br /> Steno wlChaffing <br /> Dish <br /> Piper 1-land Towel. <br /> Soap dispenser <br /> Cutting Board Sanitizer bucket- <br /> bleach 1,wafer for <br /> Propane Stove Bleach storing typing cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> [xtra <br /> Water <br /> Ice Cooler S Gal Hand <br /> wash <br /> Extra tce Bags 6 Food Containers most he Wastewater Container <br /> -""�--'--------- stored 6 inches oNof the ground! <br /> a nnn .- r r n.. _ n _ r r.a r ,.._ � ,•r.. _„•_. nrnnr r -« nnr. •.... ...r.n .- n.•..-. ..,. nwnn ..•.. .. ._ ... r..r r <br />