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S A N'J O Q Q U!N Environmental Health Department <br /> " ' --COUNTY <br /> ^ mow. <br /> Grentness grows here. <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 450F (if food is used the following day, maintain below 41 OF temperature): <br /> MIce chests ❑ Refrigerator <br /> NRefrigerated truck C�ke 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 /> s lution (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 /> 7Nater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> 71"ne separate tub (bucket or basin)for the collection of rinse/wastewater. <br /> XPaper towels and pump-style soap container. <br /> 13. Names of responsible pprsons tQ be resent in booth during all hours of operation: <br /> MCI Ile i� �Y c� <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 /> 14. Completed by: t ' eve <br /> Signature Title Date <br /> Fx-Z 5-20 Gal. <br /> Health Per Hand wash Water <br /> Stemo w/Chaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Saniuzer bucket- <br /> hteach&water for <br /> Propane Stove <br /> Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> �41Fy;r Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinquisher <br /> Extra <br /> Water <br /> Cie Cooker stored 6 inches olio t 5 Gal Hand wash <br /> 1 b ro6'01 <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> f the ground! <br /> n..__.._ I r nnn eon nAnn I r nnn Ao• nAnn i .------ - <br />