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"'"ls `y� SAN.oJGAQUIN <br /> Environmental Health D,,-partf7teni <br /> COUNT Y <br /> Grvafness grows here. <br /> 10, 1 am providing the following cold temperature control for the cold no'ding (it p„'Aenilally hazardous icy[)a5 <br /> 45'F (if food Is uaed the forRowfng day, maintain hr,low 41'F tumpornturor <br /> ®ice chests ❑Refrigerator <br /> ❑Refrigerated!ruck ❑ Ice both and tubti <br /> ❑Other(specify) — - - - <br /> 11. 1 am providing the following Rams within my booth for o)o sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink. <br /> OR <br /> ® Three deep tubs (basing 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 breach solution. <br /> 12, 1 am providing the following for adequate hand washing facilities, but separate frorn utensil wash within m; <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 rinselwastewater, <br /> ® Paper towels and um st a soap container <br /> 13. Names of responsible persons to be present to booth during all hours of operation: <br /> "Impartant" All food vendor booths are subject to inspection. Please nuke a copy of this application In <br /> preparation for this event. A copy of this checklist must be In the booth at ali hours of <br /> preparation and operation. Return original to fostival coordinator three weeks prior to <br /> this evpnt. <br /> 14. Completed by: <br /> Signaturo Title Date <br /> a-aa t� <br /> Health Permit <br /> !tame wrGRa,Mp <br /> iRaR P*or nand Tew,f i <br /> Soap Wyertfar � - �. <br /> Cuu>r+o 9oaed <br /> 3arY{tar 6&K M- <br /> 0[gth a rnta for <br /> alodrq W[Pft Elo[M <br /> PM,acR <br /> Prapana Slgre <br /> Booth must be on <br /> Concrete,Asphalt. <br /> Prywood,or o Torp- <br /> tool.an64YJ:er 1tlnlaYd„a Woa4h an6 WJ[ar Gaftge <br /> Can <br /> kTtm <br /> water <br /> Ice <br /> Cooler I L,7a1 HaM wash <br /> GGa,ca Urpa e f�d Canut.aa nr„[Ee Woaiowatn,CanlMno• <br /> �... W.,�r a�nrAsr dr rr lha p,v,ndr <br /> r [.r,:,,lt.,t+ a,,,alus ; S�r,ricl In C: tlifuin113 2(Sr T 209 .:;0-.ia?.0 - F 2004N.o 118 .:•,vu-njJ i­ nlcrlehc <br /> 7PV vl-v AY•- <br />