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SAN JOAQWN Environmental Health Depar me Rio. <br /> C ;"" U ("I <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 450E (if food is used the following day, maintain below 41OF temperature): <br /> [OIce chests U"Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑ Three compartment sink. <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 /> El/Water supply dispenser with warm water at a minimum of 100OF(i.e. 5-20 gallon container with spigot). <br /> ❑ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br /> 13. Nags f response le persons to be present in booth during all hours of operation: <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 /> t s e <br /> 14. Completed by: -- ' 60:'V'yt�ptr <br /> Signature Title Date <br /> Sri 5-20 Gal. <br /> Health Permit °: rno wfCha Hand wash Water <br /> SYcffing <br /> Dish —• <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board <br /> SaniHzer bucket- <br /> bleach&water for <br /> Propane stove Bleach storing wiping 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 <br /> Garbage <br /> Fire Extlnquisher Can <br /> Extra <br /> Water <br /> Y1�4:v 1tp �M' iV E 7 SY P(a1}I 7 1 <br /> I' �C@ COOI@f � ;,P ,�uil��+srs�Fislill��;,�r.r,.��t.sxwul � o-r <br /> i; 5 Gal Hand wash <br /> ' Exha Ice Bags&Food containers must be Wastewater Container <br /> .».<,.....„.............._,..._.......,._y stored 6 inches offofthe ground! 1 <br /> w�anr r� �:.,.....r,... «, ....... ._ .r..., _ ........ +^-.ass»»..,:_. avr^r,r.r .ro» ,n.r,.r. nw.. :.....nr. i «« .v+-,,r. •:+« s «.:n <br />