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10 1 am providing the following cold temperature control for the colt holding of potentially hazardous foods below <br /> 45'F(if food Is used the following day,maintain below 41'F temperature). <br /> ❑Ice chests ❑Re.frtgpralor <br /> ❑Refrigerated truck ❑4t;e bath and tubs <br /> ®Other(specify) Ai Aa <br /> 11 1 am providing the following items within my troth for the sanitary cleaning of food preparation utensils <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 /> ❑Delergent, bleach, and wiping cloths(cleaning towels) <br /> ❑Tub to store wiping cloths in bleach solution. <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 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 nnselwastewater. <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 /> "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 original to festival coordinator three weeks prior to <br /> this event L <br /> 14, Completed by <br /> Signature Title Date <br /> Health Permit aM vAsh Warm <br /> Srerrq rfGRifrrr� ,. <br /> rN� -:pa rh+Rr7 <br /> �aP vsp*ttSe•1 <br /> o-racn S nrHes xx <br /> �,� �,rq wpr•p CtARs <br /> gcprr� <br /> Boole,must be cn <br /> Concrete,asphalt <br /> Plywood.or a Tarp <br /> Prre(�r r�N <br /> `-+Jap�nE Witel Rv,zr YJ�rr, ECe+th arW Yl.ir Garbage <br /> Can <br /> Ln Ersrquyar <br /> r.sVA <br /> W.fe+ <br /> ` Ice Cooler <br /> '1 .lb� ar;.�W to,rv�mww lYa:dr�ntrr;„r.•,,.. <br />