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10, 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 OF temperature): <br /> ❑ Ice chests Refrigerator <br /> Refrigerated truck ❑ Ice bath and tubs <br /> ]Other(specify) <br /> i <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> hree compartment sink. <br /> OR XT <br /> i <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 /> I <br /> Detergent, bleach, and wiping cloths(cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br /> i <br /> 12. i am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> 4water supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br /> 13. Namesof responsible persons to be present in booth during all hours of operation: <br /> �)Q_v , Chr t Pit ik-2 AtaYo VA <br /> "*Important" All food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this ev, t. A copy of this checklist must be in the booth at all hours of <br /> preparation and opedfio . Return original to festival coordinator three weeks prior to <br /> this event/ <br /> 14. Completed by: <br /> y ignature Title Date <br /> :;_ �-��:�?•r�,� � s•zo cal. <br /> Health Permit Hand wash Water <br /> Sterno wiChaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting Board Sanilizer bucket- <br /> bleach 8 water for <br /> Propane Stove <br /> Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tale. <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher ! <br /> Extra i <br /> Weter <br /> Ice Cooler 5Gal Hand wash <br /> Extra Ice Bags 6 Food Containers must be Wastewater Container <br /> stored 6 inches off or the ground! <br /> I <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP i <br /> 08/01 116 <br />