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S <br /> R EC-Cos i <br /> (• r " t- . o <br /> A N.'.,f Q Q QU I N Environmental Health Department � <br /> C O U N 1 Y- 1 <br /> �:F,rleVION0 '' C7rout,njv55 grows herv. <br /> 10. 1 am providing the following cold temperature control for the cold holding of polentlally hazardous foods below <br /> 50F(II food Is used the(ollowin ,maintain below 41°F temperature): <br /> foe 011%ts rigerator <br /> ofrlgerated truck BeIc bath and tubs <br /> Cher(specify) <br /> 11. providing the following Items within my booth for the sanliary cleaning of food preparation utensil <br /> ORhroo compartment sink. f <br /> ®Three deep tubs (basins 6-8 Inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> I-10}Ion (one tablespoon of bleach per gallon o1 water). I <br /> etorgeni,bleach, and wiping cloths(cleaning towels). <br /> Sublo store wiping cfolhs In bleach solution. <br /> 12, 1 am providing (he following for adequate hand washing facllfiles, but separate from utonsil wash within my j <br /> booth: ! <br /> I <br /> �Nater supply dispenserwlth warm wator at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> S�)no separate tub(bucket or basin) for the oolleclion of rinselwastewater. <br /> 'aper towels and hump-style soap conialner. <br /> 13. Names of responsible parsons to be preseni In booth during all hours of operation: <br /> Darnel & Cecilia Guy <br /> "Important" All food vendor booths are subject to inspection. Please matte a copy of this application in <br /> preparaVon for this event. A copy of this checkilst must be In the booth at all hours of <br /> preparation and operation. Flelum original to festival coordinator three weeks prior to <br /> 14• Completed by: Cc-Owner Og11812024 i;;:SUBMI,T''j I <br /> 1 nalure Title _ Date <br /> h-20 f3gl, <br /> i-�ealt}i I'C`i'lllll FinndvmshYlalor <br /> 91nh?o wTharin5 <br /> Gish <br /> Vapor FtnaYTavroka <br /> Boap dspontor <br /> Cu1GnF,Dao«1 SnnllluuAuekel- <br /> irioncll RwatarlCr <br /> Prapana&avn <br /> plan[!1 - abfla�vAprn�[blllf I <br /> Booth mwit tie on <br /> Concrole,Mpholl, <br /> Plywood,or u Tflrp. <br /> 6aapanlwnlor ninsgwnser ManchnngMat �itrf�pflr) <br /> Con <br /> •` ,"` FiroEapnrtulli <br /> L"lrA <br /> wanr <br /> Ice Cooler 6anllianiwooll <br /> &Aira ka rings R load Gaala Owl h, LN-Vwaaslnvrelor Cdllaingr <br /> twod GJAMRsON011haproundl <br /> 1866 R.Haxellon Avenue I Slociklon,Caillornla 05205 I T 209 468-3420 I F 209 464-0138 1 www,sJgov,org/ehd <br /> PH4 is-op Pagn a 0111 TEIAP EVENS APP 1 <br /> oart�ns <br />