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; <. 11JSAN HIAUUIN ' i i ! i t •;!; 11 <br />10 <br />•witlit;ny cleaning of food preiKiralion utensil <br />11 <br />OH <br />12 <br />13 <br />“Important** <br />ConipleK’d by14 DateTitleSignature <br />\ <br />I <br />I I <br />Ice Cooler <br />'iwi,.!ii • r; <br />/ <br />o dio I h jj.'i ' <br />■ i li i/' ‘l:.t> '■ <br />i ni> ir. 3? <br />lUiolh 'iitisl be <b‘ <br />C(wi<.it::i: /’»•>! I'iill <br />PlywiKHl «>' a '•bl' <br />I .»»»:»«! ii • •• i <br />, an, proving the fo.low.ng coh! tempore control for the cold holdmg of potonliaHy hazardous foods hduw <br />4<ri- (il food is used the following day. maintain below 41 I temperature) <br />| | Ice chests i lH<!h''!e'''h» <br />[ | Rcffigcraled truck I I Ice bath and tubs <br />| Other (specify) <br />I loalth Permit | <br />I am providing the following items within my booth tor tin: <br />| | I hrcc compadnicnt sink <br />| | Three deep lute (basins 6 » inches nsn.niurn), one (or soupy «.(r:r, one (or r,,,»!,«) rrnd orur lor o (*®l> <br />solution (one tablespoon of bleach per gallon of waler) <br />| | Detergent, bleach, and wiping cloths (cleaning towels; <br />| I ub Io store wiping cloths in bleach solution. <br />I an, providing (he Mowing (or udoqmte hand washing (acrm.es. (»« sep.-rralo Iron, utensi, wash wdlrin my <br />booth <br />Stwaler supply Sponsor wnh warn, water nt a minimum rd 100 I (i o S-20 (PlM «>nlamer wth spigot) <br />basin) for the collection of nnsc/wastcwatcr[X()hn separate tub (bucket or <br />'^H’aper towels and pump-style soap container <br />dames o' -csponsiblo persons to be present in booth during all bouts of operation <br />oxw v-exlM. <br />All food vencim booths ate subject to inspeciio.t Please make a copy of tins hpuhcation m <br />ore anon for this event A copy of this checkhsl must be m the booth al all bouts of <br />preparation and operation Return original to fostival.cpprdinator throe weeks pno.i to <br />this event.