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i <br /> 10 f am provielrnq rho inrinwrrrq Nllrl lomryr,orpt++rA rYrnirM for tho rn i h64'lin1 of [1olmfrally hazardous foods below <br /> 41."F ill FCcx1 it,ucrvl fhp ttrifnWrrQ m:1rMArn Gninw 4l'F rk,"Ar.ihrrn) <br /> I iop ChFKtr ( J itl+frrprtRllmlr <br /> k8fn1pr,9?M[dirk f ) I(^b,Hh trrlrf hrir4 <br /> [�olt'm fsvno m <br /> 11 !A-tlrrlvtl1fnQ Irrf`fnllrwrnq lJOn'A wrthtr.my txwrtt,fix thn 14A(WAry r.FA (If fr�nri preparation ulens[Is: <br /> D Thrfap r"c+rn11AIlmonl crltk <br /> OR <br /> Thrive dome tuhc (t4'tem9 F ft rnrl'104 mli imirm), tlnfa f6r ,dopy w,,41r3r• Ono fnf rinsinq and One for a bleach <br /> R1,00n0h lnnp fahlr*,,pt)nn of hie%A('h rot patinn e)f Watrnr)• <br /> DPleW(`nt. Nra&,aml wlrrnq rfnlhe firlr+ininq towels). <br /> Tuts 10 chirp wiping Cfnlhe in hiPach sofuhnn <br /> 12. 1 am pro"ding the following for adequate hand washinq facilities, but separatfl from utensil wash within my <br /> booth <br /> Lister supply dispenser with warm water at a minimum of 1001F (i.e. 5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> (Paper towels and um -st le soa container. <br /> 13. Names of responsibl persons to be re nt in booth during all hours of operation: <br /> 4 <br /> "'Important" -Ali 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 on inat to festilral coordinator three a a <br /> 14. Completed by: <br /> Signature Title Date <br /> 5.2� Gat <br /> Health Permit Hand wash Wow <br /> Slerno wlchalfing <br /> crab <br /> Paper liana Taweb <br /> Soap dlapenses <br /> Crrtrirp Board 1 Sanktizer 13ucke[- <br /> IJ Llea�8 wafer tar <br /> Propane Sieve Bleach storing"Ping cloths <br /> Booth must be on <br /> Concrete,Asphalt <br /> 1 Plywoo[i,or a Tan <br /> f <br /> Propene Tank ... - - ..�..� ......�... _..._.. ....._._..�. ..._�_ _ <br /> Sup*nv Waler Rinse nays- B e h a id Water Gartage <br /> Can <br /> "4 Rea EMlrClUsher <br /> {£ 4 'rare• <br /> 1'Ce Cooler 1• i .. <br /> il 5 Gat Hand vrasts i <br /> aft IM aag&d FoodConfarners inusr be LVI <br /> tsatewator Container 4 <br /> skxad 6 aldm off d me grotax <br /> i HO 16-02 Page 8 of 11 FE1MP E yf MT AJ <br /> (7" !16 <br />