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j <br /> 4i <br /> S A N J O A Q U I N Environmental Health Department <br /> -COUNT Y <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> ZYF(if food is used the following da , 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 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 /> ❑ 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 /> j Paper towels and pump-style soap container. <br /> 13. Names of responsible-persons to be sent in booth during all h�uts of operation: <br /> :7 0.tQ- Kf' 'tic (— (�� <br /> ax <br /> of this application in <br /> `*important"" All food vendor booths are subject to inspection. <br /> checkPlease <br /> st must be be in co <br /> Ahe booth at all hours of <br /> py <br /> preparation for this event. A copy of this <br /> preparation and operation. Retum original to festival coordinator three weekslp`6ar-to <br /> this event. 190jg L—�---7 <br /> 14. Completed by: Signature Title Date <br /> 5-20 Gal. <br /> Hand wash Water <br /> Health Permit Fstemo%wchafbng Paper Hand7owels <br /> Dish <br /> Soap dispenser Sanitizes bucket- <br /> bleach&water for <br /> storing wip ng doths <br /> CLC'ng Boars <br /> Bleach <br /> =C;ncrete, <br /> Propane Stoves <br /> OI <br /> • a-arc Bleach and water Garbage <br /> soap and water Rinse water Can <br /> Fire Exlnpuisher Extra <br /> �-.` water <br />