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:0. I am providing the following cold temperantre control for the coid.hoiding of potentially hazardous <br /> foods *below 35 F: (check one or more boxes) <br /> {� ice chests refirigerator <br /> [ ] refrigerated truck [ ) ice bath and tubs <br /> [ ) other (specify) <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food-preparation <br /> utensils (check both boxes): <br /> two deep tubs(basins 6-8 inches minimum), one for soapy water, the other for rinse and <br /> bleach solution <br /> [iY detergent, bleach, and water (one capful per gallon of water) <br /> 12. I am providing the following for adequate handwashing facilities, but separate from utensil wash, <br /> within my booth (check all boxes below): <br /> [] water supply dispenser (eg. 5-20 gallons, Igloo or Coleman container with spigot) <br /> one separate tub (bucket or basin) for the collection of rinse/waste water <br /> O Lj� paper towels and pump-style soap container (or squeeze type), and lined sash recepmcle <br /> O <br /> rye 1:. Names of responsible persons <br /> ggt��obe present in booth during all hours of operauea: <br /> H <br /> IIMPORTANM All food vendor booths are subject to inspection. Please make yourself a <br /> copy of this checklist in preparation for this festival. A copy of this checklist must be in <br /> IH booth at all hours of preparation and operation. Return original to festival coordinator two <br /> months prior to t . even <br /> 14. / ,{�I1 V�� <br /> z �S LJ // ^^W''� <br /> Q signed title date <br /> 104 10 z 10 FT. BOOTf ', - NO <br /> HEALTH <br /> ( SMOKING PERMITPQ <br /> r <br /> W <br /> E-i <br /> I <br /> STE.RYO AN <br /> .i PAPER H01.. . I <br /> IV/C'riAEFING 7158 I BLEACH ,TOWELS I <br /> 1'•D <br /> �� r .. '• Ic'} w\L. :1ANOVASH <br /> PROPANYATEd I <br /> 7 <br /> E SiOvE <br /> •� _ <br /> Jit :OAP - 3LEACH -i ISCFT SOAP <br /> ^rti Ui 'iA iC -� r t <br /> -R h•�—. YA TER 15P-RSER <br /> (�-_:" � ` BOARD _ 'T' . <br /> r• - I l GARBAGE CAN; <br /> HAHOYASH' <br /> _ 11 . TE WATER CONTAINER <br /> I ICE TAS_ � <br /> iCOOLEd EIRE <br /> EXTINGJ:SHED <br /> ' � fOCO COKTAINEZS !CS' <br /> `S1RA ;C: BAGS HOST 'E ST7CED Cf"- .i THE <br /> E STORE] 9:r Of SHE FLOOR <br /> iOUNo <br /> CONCREic, A$2HAL1 , <br /> PL•.W000, OR TARP <br />