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< r <br /> SA N J OAQ U IN Environmental Health Department <br /> 1; C O U N T Y-----.. <br /> Greot'ness Brows 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°F temperature): <br /> N 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 /> JA Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> olution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> 9 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 /> 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. Names of respgnsible persons to be present in booth during all hours f op atio <br /> elf Ma►� ' Ella on -a s <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 eve <br /> 14. Completed by: � &iwY— •s ZS� <br /> Signature Title Date <br /> T. <br /> 5-20 Gal. <br /> Health Permit Hand wash Water <br /> Stemo w/Chaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanitize,bucket- <br /> bleach&vrater'or <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 /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinquisher <br /> Extra <br /> Wa[er <br /> �Ce C��l�(' ( ,7 0 firth i � Ya 1'k 'ittr7 °� ii131' t�i 5Gal Hand <br /> wash <br /> Extra Ice Bags 6 Food Containers must be Wastewater Container <br /> stored 6 inches otfol the ground! <br /> 1 nA__I.a_._ n_I:r_.-._:_ nrnnc 1 T ^^^ A/n nA^n 1 A! A l nn I <br />