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4 <br /> 10 I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45°F(1f food is useV the day,maintain below 41OF temperature): <br /> N®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 /> 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 /> ❑Detergent, bleach, and wiping cloths(cleaning towels). <br /> ❑Tub to store wiping cloths in bleach solution. <br /> I am providing P&foflowing for adequate hand washing facilities, but separate from utensil wash within my <br /> i booth: TN®Water supply dispenser with warm water at a minimum of 100eF(i.e. 5-20 gallon container with spigot). <br /> ®One separate tub(bucket or basin)for the collection of rinsetwastewater. <br /> ®Paper towels and um -st le soalp container. <br /> 13. blames of responsible persons to be present in booth during all holys of operation: <br /> u-,5 w 0"4--. t La -4 ,)a.,� t<t_!`V V-%0/ <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. <br /> 14, Completed by: C I'n 20'L'-f <br /> Signature Title Date <br /> s za Gai <br /> Health Permit <br /> Hasawash Wale• <br /> SieRto +Cha'tvg <br /> D <br /> Paper Hand Towels <br /> Soap disponse <br /> Cun•np bard ' Sanrozer bucket- <br /> bleach E wale,IV <br /> Propane Sto.e Bleach stone wrpng 00,hs <br /> [tooth must he on <br /> Concrete,Asphalt, <br /> _ Plywood,ar a Tarp. <br /> Prowe Tani _------ — —--- --- — -- -- . - - - <br /> soap a• wale, Rrrs Water 8teach a'rC Wala <br /> —• Garbage <br /> fae Ed,nq�rshe+ Can <br /> W r <br /> Ice Cooler 5Gal Hand wash <br /> Exrra Ire Bags d Food Comame7s mus!6e waslewaler Conlarner <br /> seared 6 ruches oft of Me ground <br /> EHD 16-02 Page 6 of 11 6810111E TEMP EVENT APP <br />