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4==. SANJ QAQU I N Environmental Health Department <br /> COUNTY <br /> Creotness grows here. <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 of temperature): <br /> ❑ Ice chests ELRefrigerator <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 /> 4 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 1 OOoF(i.e. 5-20 gallon container with spigot). <br /> 91 One separate tub(bucket or basin)for the collection of rinselwastewater. <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 /> n1!5 ��ay atyr2 -- <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 event. 11 <br /> 14. Completed by: _ 1 o DJL 1Q _ � aZ_. __ u:vte ZZ.= <br /> Signature Title Date <br /> 5,20 Gat <br /> Health Permit <br /> Stemo wfChafPing Rand wash Water <br /> Dish Paper Hand Tev`els <br /> Soap dispenser <br /> Cutting Board Sandizer bucket- <br /> bleach&waterior <br /> Propane Stave <br /> Bleactr storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> A , Fire Extinguisher <br /> Extra <br /> ' V4tater <br /> Ice Cooler 5 Gal Hand wash <br /> Fx6a fce Sags&Food Containers must be Wastewater Container <br /> stared 6 inches off of the ground' <br />