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10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45'F: <br /> ❑ Ice chests ❑ Refrigerator <br /> ® Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food-preparation utensils: <br /> ❑ Three compartment sink. <br /> J4 Two deep tubs(basins 6-8 inches minimum), one for soapy water, the other or rinse and bleach solution. <br /> [q Detergent, bleach and water(one capful per gallon of water). <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> Water supply dispenser(e.g. 5-20 gallons, igloo or Coleman container with spigot). <br /> ❑ One separate tub(bucket or basin)for the collection of rinse/waste water. <br /> ® Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> ct-4 '5 M0'C-r4E-C1S <br /> ""Important: All food vendor booths are subject to inspection. Please make yourself a copy of this <br /> application in preparation for this event. A copy of this checklist must be in the booth at all <br /> hours of preparation and operation. Return original to festival coordinator two months <br /> prior to this event_ <br /> 14. Completed by: Lrpa1 <br /> Signature Title Date <br /> KEwak-u� e�u8 � <br /> ID 10 ft Booth Health Permit <br /> No Smoking Sign 2 111 Gal <br /> _ Hand wash Water <br /> Sterna WChafhng <br /> Dish <br /> Paper Hard Towels <br /> Soap dispenser <br /> Culling Boats <br /> Bleaul <br /> Propane 51aYe Must be an <br /> Concrete.Asphalt <br /> Plvwood.or a Taro <br /> Propane Tank <br /> Garbage <br /> Soap and Water Bleach and Water Can <br /> O Fire E>tlinguisher <br /> EHtra <br /> Water <br /> rim Confer Eifra Ice Bags must be slored off of the <br /> gr000dr 5 Gal Hand wash <br /> Food Canlarrrera mull be stored oft of[fie Waste water Container <br /> ....__... floor? <br /> EHD.16-01-O02 Page 8 of 9 TEMP EVENT APP <br /> 817r2003 <br />