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S A N -J 0 A Q U 1 N Environmental Health Department <br /> C O U N T Y------- <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 following day, maintain below 41°F temperature): <br /> M Ice chests ❑ 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 /> dThree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> sol ion (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> F�ub 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 /> Water supply dispenser with warm water at a minimum of 100°F (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. N mes of responsible persons t be prese in bo th during all hours of o eration: <br /> irt� Teo ozo, n P pil l <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 event. <br /> 14. Completed by. <br /> Signature Title ate <br /> m ;�e <br /> Health Permit hw <br /> Stemo wfChatfing Hand wash Water <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanitize,bucket- <br /> bleach 8 water for <br /> Propane Stove Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> O Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and WaterIF Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Nlater <br /> Ice Cooler 5 Gal Hand wash <br /> Extra tce Bags 8 Food Containers must be Wastewater Container <br /> stored 6 inches offof the ground! <br /> r+_ct__:- ^-n I r nnn ♦Cn nAnn I r nnn •cn nA nn I ------ _:_. <br />