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i <br /> 1-0. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45e17(if food Is used the following day,maintain below 41 OF temperature): <br /> ❑ Ice chests ❑Refrigerator <br /> ❑Refrigerated truck, ❑Ice bath and tubs <br /> )9.Other(specify) 1!3 AM .v <br /> 11. 1 am providing the following items within my booth for warewashing: <br /> ❑Three compartment sink. <br /> OR ' <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 /> 12. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> -ouetergent,bleach,wiping cloths(cleaning towels),and a tub to store wiping cloths in bleach solution. <br /> 13. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br /> YePater supply dispenser with warin water at a minimum of 100*F (i.e. 5-20 gallon container with spigot). A <br /> ate tub (bucket or basin) for the collection of rinsetwastewater. Paper towels and a ,pump-style soap <br /> container. <br /> 14. Names of responsibl erso s to be present in booth during all hours of operation: <br /> IoQkA <br /> **Important** 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 orinlnal to festival coordinator throe weeks Prior to <br /> this event. sot 15. Completed by: C'S1Tit��,fj,yG_ --� �,w t 1 <br /> gnature Title e <br /> 1.�•;�r,::.:.•;,aa_::,1-v.:}: ! 5.20 Gal. <br /> Health Permit t Had wash We,., <br /> Slorno WlchellinB ...._ <br /> Dish <br /> Paper Hand Tmvets <br /> Soap dispenser <br /> Cull(ng Board - SanlBzer bucket- <br /> ,,,each&Wolor for <br /> Propane Slova <br /> Blanch storing wiping claBts <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> i <br /> PropaneTank ' '-- - .. .. .. .. . .......: .... _. .:...'--• .. _..._... ; :.......:.-_..... <br /> Soap find Waicr 111—Waler Dleach and wafer Garbage <br /> Can <br /> Fire Exttnptdsher <br /> Exlre <br /> Wdar � <br /> Ice Cooler J <br /> k ';q;.':;.:(:;:i;.-:!>,:;,.y;.z�.t„ ;.i'•�;: :::::�1 5Gal Mend Wash <br /> Extra Ica Bags R Food Conlainots must be waslewoler container tr <br /> __....^...___.___......._.•' stared 6lnchesoHor(hoBroundl ' <br /> II <br /> I� <br /> Oil)16.02 Pago a of 11 TEMP EVENT APP �I <br /> 7/14/15 <br />