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S A N J O ll() IJ I N f rrviI-oil trier)taI Health Depal-trnclit <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods beleW <br /> 45'F(if food is usod the following day,maintain below 41'1'temperalure) <br /> [_ Ice chests []Rofrigorator <br /> ( f 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 /> [-]Three compartment sink. <br /> OR <br /> [] Three deep tubs (basins 6-8 inches minimum). one for soapy water, ono 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 /> [_J Tub to store wiping Goths 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 100°F(i.e.5-20 gallon container with spigot). <br /> r]one separate tub(bucket or basin)for the collection of rinselwastewater. <br /> []Paper towels and p�lmpslyle soap container. <br /> 13. 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 /> proparation for his event. copy of this checklist must be in the booth at all hours of <br /> preparation d o eration. eturn oric anal to festival coordinator thre week prior to <br /> this event C lri1 ) <br /> 14. Completed by: <br /> Title bato <br /> f5-70 Grd <br /> LIiealttl f'ermlt — I Band w4sh W�kr <br /> _F � 1 ,Iel1glQ�larlll� ll �- <br /> hrsh <br /> 1'r?erl4ntl taw41" <br /> Crrrm,11i4ard J —_ $oso Ar alwfo <br /> WOle1r R Malp ry <br /> f44Wm45fo•e � 1l14ach_ "IQrtnQ wP"1p CWIAS <br /> —_ liootl,least hC on <br /> Concrete,Asphalt, <br /> Nywood,or a Tarp. <br /> �� SQJP arwl WalOi Itu.sv W"Iw 14caQh ar'd WAl4r <br /> Cali <br /> � 1'KP Frrp.ailrW <br /> f+un <br /> Watt' <br /> �Ice Cooler :Cal Ilandwasm <br /> F.-rrra kv Nags 6 Vood C"M-no+a rn W he Waak.a:4r C.aaMrrn <br /> Stawd 6 v heson of Rro(P•avrsdr , <br /> 1 156 1. I Iarclton Avanuel T 2011 46U-34a0 1 1: 209 464-0138 ( www.:,lyav urg1ohli <br /> VIC)16.02 Page B of 11 rl Mn I�VILNI AV!• <br /> OGr,9r,9 <br />