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Title Date Signature <br />Health Permit [i <br />! Sterno w/Criatfin3 <br />Dish <br />I <br />5-20 Gal <br />Hatal wasn Writa,- <br />Scat: dispenser <br />Saniazer ute,01- <br />t!cazn water tcr <br />storing ring clothe <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood. or a Tarp <br />Fire Exlinou shat <br />Water <br />Extra <br />Garbage <br />Can <br />Ice Cooler <br />I Eska :OS ea3s & Food Conte,rers most be , Sforatl 6iiwites Oct the ground' , <br />5 Gal Haw %%3th <br />INttwater Conta rat <br />SAN JOAO IN <br /> <br />Environment. Health Department <br />10. I 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 0 Refrigerator <br />0 Refrigerated truck 0 Ice bath and tubs <br />D.Other (specify) <br />1.I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <br />OR <br />D 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 />El Detergent, bleach, and wiping cloths (cleaning towels). <br />LI Tub to store wiping cloths in bleach solution. <br />12. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />E One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />D. Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <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 this event. <br />Completed by: <br />1•- .--- EHD 16.02 <br />0 5 /29/2023 Page 8 of ti <br />TEMP EVENT APP