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SJC HSA P 2/212092017-05-05 17:37 /ahh IncJ er <br />io. <br />I am providing the following itoms within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />13.Detergent bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths In bleach solution. <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Names of responsible persons to be present in booth during all hours of operation:14. <br />■“Important** <br />15.Completed by: <br />'Signature <br />Health Permit P <br />Papac Hand Tow«U <br />I Soap CUpanaar I ___ <br />CUano Board | <br />PrcpanaStov* <br />I Propana Tank i&r <br />Bleach and Watar <br />Rra Cxanouaher <br />Ice Cooler j <br />P«O»0of11 TEMP EVENT APP <br />Rlnia Water <br />EHD 10-02 <br />7/14/16 <br />0. Water supply dispenser with warm water at a minimum of 100*F (l.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pumo-stvle soap <br />container. <br />13. 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 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />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 />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 />thhiavant. a <br />□ Refrigerator <br />□ Ice bath and tubs <br />8 0*1 Hand uatn <br />WMtawater Container <br />Sanitter budcat. <br />bleectifc water tor <br />•Wring wWno SWw <br />Stame w/Chafflng <br />Dim <br />Sxn <br />Water <br />Gamage <br />Can <br />Booth must bo on <br />Concrata, Asphalt <br />Plywood, ora Tarp. <br />Cart f‘ood Conlalnan mutt fie B <br />att/K/dtoc/HM off or Uionrounai ■ <br />—r <br />Soap and Water <br />Title Date <br />M2 Oal. <br />Hand watt Water <br />Beach