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10. 1 am providing the following cold temperature control for the cold holding of potontlally hazardous foods below <br /> 45`F(if food Is used the following day, maintain below 41 rF tomporaiure): <br /> ® Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify)_ <br /> 11 1 am pruvidng the folbwing Items withn my booth for the sar►itary cleaning of food preparation utensils: <br /> ❑Three compartment sink. <br /> OR <br /> ® Three deep tubs (basins " 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 /> 0 Detergent, bleach, and wlping cloths(cleaning towels), <br /> ❑Tub to store wiping cloths In bleach solution. <br /> 12. 1 am providing tho following for adequate hand washing facilities, but 6aparWe from utensll vrash within my <br /> booth-, <br /> ® Water supply dispenser wlth warm water at a minimum of 1DO"F(i.e. 5-20 gallon containervnth spigot) <br /> ® One separate tub(bucket or basin)for the collection of nnselwastewater. <br /> ® Paper towels and 5oap container. <br /> 13, Names of responslbla persons to be prrrserit in booth during ali hours of operation: <br /> Brian,Faith,Rhea Motley <br /> "Important" A!I food vendor booths are subject to Inspecton. Please make a copy of this application In <br /> preparatln for this event, A copy of this checklist must be in the booth at aI hours of <br /> preparation and operation. Raturn original to fetttrvai coordinator three weeks osiQr tQ <br /> this event_ <br /> 14. Completed by. <br /> 5/14/25 <br /> Signature Title data <br /> S:4 Cr <br /> Health Permit Kam Waspss.rW <br /> h fth <br /> W:rl Nrrd T,rwrl� <br /> CutVO r}v. - .�vler t..s.�- <br /> bw.r114�kr rr <br /> f}"_Wrr Etc. 5r�� �M�.tripi3;C• <br /> SocrLh mLnd bo on <br /> coR7ele,A&PhalL <br /> -«K:a., 4 •I Plfmood,or a Tarp <br /> 15.1Ep al-Voy 1a Fl•r 4k'aW Owrri a111 Wa6r <br /> Garbage <br /> r,.r A r.•.. ,_ -.l can <br /> room <br /> i <br /> Ice Cooler I <br /> 9 Gal F4rW wva <br /> J Est9 ki A f,d C-n14WW,MAI,e N'..rr.Lwr C,—Urw <br /> E-VT6C2 rime6d1t <br /> TE%1a E1'ENT AAFI <br />