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10. 1 am providing the following cold temperature control for the ccld holding of potentially hazardous foods below <br /> 45a (f food is used the following day, maintain below 41'F temperature): <br /> ,,:2-fr-e chests ❑ Refrigerator <br /> ❑Refrigerated truck ❑ Ice bath anti;215trier(specify) <br /> 1 1. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils.- <br /> El Three cormoartment sink. <br /> OR <br /> ❑ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and ore for a bleach <br /> solution fune 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 /> 12. 1 am providing the folbwing for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ❑Water sNprly dicPnnTor with warm wafor at a minimum of t 00'F' (i.o. 5-20 gallon container with spigot). <br /> ❑ One separate tub(bucket or basin)for tha collection of rinse/wastewater. <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 /> ' (LAC, "e, <br /> 'Important" All food vendor booths are sibject to inspection. Please make a copy of this application if; <br /> preparation for this event. A copy of this checklist must ba in the booth at all hours of <br /> preparation and operation Retum original to festival coordinator three weeks prior to <br /> i e ent. � r <br /> 14. Completed by: � y,2,12 <br /> Signature Title pate <br /> 5-2o Gal <br /> Health Permit Hand wash Water <br /> Storno wfChaRi n9 <br /> Dish <br /> Pape nano l owe1; <br /> Sn:p di:percar <br /> (:utirua Board �� 5annzerbut+et- <br /> bleacl&water for <br /> Propane Stave Bleeth storing wiprrg colhs <br /> Booth must be w <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> F'roene lank <br /> ------------- <br /> Soap end WaSar Finse Weer Bleach and water Garbage <br /> Fire Extinguisher Can <br /> Extra <br /> Water <br /> �ce CAoTer - - — -- -_-- - - - 5 Gal Hand wash <br /> Extra Ier&oas&Food Cofalne�s must be Wastewalar Container <br /> - ctnn.�R,nrhes o7nl:hc 5rourrfl <br /> EHD 1E-02 Page a of 11 TEMP EVENI AP' <br /> 08101/16 <br />