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S AN J OA Q U I N Environmental Health Department <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 aF 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 /> Q 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(Le. 5-20 gallon container with spigot). <br /> ❑ One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> [x Paper towels and um -st le soap con%g9r'wash sink with hot water in food t ruxm <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Gary Blanco <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 v n 12/3/2024 <br /> 14. Completed by: owner <br /> Signature Title Date <br /> 52a C;nl <br /> Hand wash Walrr <br /> Health Permit <br /> 5lerno wlChnlTlrq <br /> Dish Paps,Hand Tawals <br /> 5aeo Q+3peaSaf <br /> Cu[i�np 9oa+a sanlhterbuckel- <br /> bleach d water+m <br /> atornng wgkv,dolha <br /> Qrogana 51a�e aleacn <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Snap�nrl Walen Ftnve Water gleach and WAlcr Garbage <br /> Can <br /> Fan Fstinqulshar <br /> Fnra <br /> Weler <br /> Ice Cooler 5Ga4rlendwash <br /> Exha rcn Hags a Food conlnu�ers musl he wastewater Container <br /> sfo.aa 5 invhas allot rhs gm.ndf _+ <br /> 1368 E= I Slockl I t jllfoi-n a`1S2105 1 T 209 463-342u I F = <br /> EHD 16.02 Page a of 11 TcMP CVLN 1 APP <br /> 06129/2023 <br />