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SANdOWIN Environmental Health Department <br /> COUNTY <br /> ll <br /> V <br /> crecoluosi qrcwi� herc. <br /> I any providing the following cold tempamtore mntrol for the wId hoWing of potentially hazardous foods Wow <br /> 45°'17 fif rood is used Die following day,maintain below 41"F teruporature)z <br /> 0 Ice Chests 191 ReMigeralor (See on the following page) <br /> El Refrigerated truck EJ Ice bath and tubs <br /> KI Other(spacify) All cuprakes are pre-packaged before arriving to site <br /> I am proAding the,follaMng 11oms w1thin My booth for the sanitary cleaning of food preparation utensil <br /> Ej Three cornpartmeqt sjM, <br /> OR <br /> El Three deep Willa(basins " kiches MInImUM), one for soapy water, one for rinsing and one for a bl000h <br /> solution(onatablespoon of bleach pargallon of water), <br /> E]Detergent,bleach,and wiping cloths(doaTdnq tomls). <br /> 0 Tub to store wiping cloths in bleaoh sofu(lon. <br /> 12, 1 am providing, the follio-Mrig for adeqxiate hand washing facifilles. but separato ffm. i utensil Wash wIthln my <br /> booth: <br /> Water supply dispenser vilth warm water at a Mnimum of 1 OWF(Lo,5.2.0 plion contain'Wr With spigot), <br /> Onasapm-ate tub(bucket or basin)for the wilpcflon of rInseNjasleAvater. <br /> Paper towels and purger style soap container. <br /> 41 'Names of rcspansibka persons to be pressra I;i booth during all hours of operaWn: <br /> Lisa Brighton, Connie Brighton-Wooten,Travis Wooten <br /> "Importan tlr* All food v@ndcyr Walhs Rm subject to inspection, Please make a copy of this application in <br /> preparafion for this event. A copy of this che—oklia mttst he In the booth at all hours of <br /> preparation and operaClon. Return original to fastivni coordin-at-or three weeks prior to <br /> this event. Pringigal, EBIC <br /> 14. ComplAted b <br /> Title Date. <br /> 6,20 ad, <br /> Haafth Sind w2sfiWar gr <br /> Permit <br /> V Vann g B 00 ris <br /> sooth mmi be on] <br /> Ccaicreta,Asphalt, <br /> V Plywood,or a Tarp. <br /> r4 or-awaiw M40 WOW VkW1A0M%V&W <br /> Garbage <br /> Call <br /> Fk*F. k%p-juiior <br /> Ice Cooler 5 C Ll H A rog.kw sop <br /> Evm ka Rog g&R od Co*V&s m7m b* W"Awrior canwwr <br /> Now a WOW effArfttmuto I I - . .. <br /> 1868 E.flazelton Avenue I StooRtan,California 95205 1 T 209 468-3420 j F 209 464-0138 vAv"jqovorg/ehd <br /> 040 io-02 F1699 41 or 11 TEPAP EVEWT APP <br />