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i <br /> 2 <br /> 10. 1 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): I <br /> ❑Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ®-Mer(specify) <br /> r <br /> 11. 1 am providing the following items within my booth for warewashing: <br /> ❑Three compartment sink. <br /> OR <br /> hree 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 /> 12. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> ❑ Detergent, bleach, wiping cloths(cleaning towels), and a tub to store wiping cloths in bleach solution. <br /> 3$ <br /> I <br /> 13. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br /> t ater supply dispenser with warm water at a minimum of 100'F (i.e. 5-20 gallon container with spigot). "A <br /> separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap l <br /> container. <br /> 14. Nam, s of responsible persons to be present in booth during all hours of operation: <br /> "Impo ant" All rood 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 yrior to <br /> this event. <br /> j a <br /> 15. Completed by: <br /> Si nature Title Date <br /> {:.:; e.,,:';.,..l:.,;,:1`.l'_;'•,;"�MJ 5-20 Gal. 3 <br /> ��`Health Permit 1jjj Hand wash water <br /> Slernow/Chafing <br /> Dish <br /> Paper Hand7owols <br /> 3 <br /> Soep dispenser <br /> Cuffing Board Sanifter bucket- <br /> bleach&water for <br /> Bleach storing wiping cloths <br /> Propane Stove L <br /> Booth must be on K <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> y <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisherh <br /> Extra � <br /> Water 3 <br /> Ice Cooler f=•.ir. ;'_?:;T='i.:;,:`, ::r _T: 5Gel Hand wash <br /> ---��: Extra Ice Bags 6 Food containers must be i Wastewater Container <br /> ---•----------'-- stored 6 inches of(oftheground! s <br /> E <br /> 7 <br /> a <br /> 3 <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 7/14/15 <br />