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S A N J 0 A Q U I N Environmental Health Depaftment <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 /> ❑ 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 /> ❑ Three deep tubs (basins " 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 wlping 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 rinsetwastewater. <br /> ❑Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> jriseph C •a <br /> "important" Alf 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 ell <br /> preparation and operation Return original to festival coordinator three weeks prior to <br /> this event. ) t <br /> 14. Completed by: — ). _ Owner/Operator 12/2/2024 <br /> �;4gn Lure Title Date <br /> f Health Permit Flan�'vrnenwalr: <br /> Stemo wlChat`•a <br /> Olsh pMyf}IYW 7ory6 <br /> I <br /> Cutnrq 6pard / SYr�IRw GucicN <br /> � 41reh 6 waist for <br /> Propane Sloan <br /> r11ClU r xtonng w ii des <br /> Jf1 mp <br /> Booth roust be on <br /> GoncrBtu.Asphalt, <br /> Plywood,or a Taro. <br /> Vruuanu lanA <br /> Soap and wAtac am YJaler GBft18g9 <br /> Can <br /> Flu Cs�npuraher <br /> F_xlra <br /> Winer <br /> Ice Cooler SCal llanA w,e1. <br /> EabH Iry 9apa a Feprl ennuwws m.af be waelew.,Ci.A mnr <br /> arrxed d nrhas aH o!Ma gromd! <br /> 666 C T _"1'rJ v.:i J5_! '' F �,iJ 4h`• :1 !r, nrvsi!Si!V l.�ni] <br /> El-10 7&q2 Wage 9 of I TEMP EVENT APP <br /> 01521119119 <br />