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10. 1 am providing the Uowing cold temperature control for the cold hoiding of potentlally hazardous foods bekhv <br /> 45'F (d food Is used the following day, mainialn below 41'F temperature)-. <br /> ® Ice chesb ❑ Refrigerator <br /> ❑ Refrigerated truck ❑!ce bath and tubs <br /> ❑Other(6pedy) <br /> 11. 1 am provndlr►g the following items withln my booth for the sanitary cleaning of food preparation utensils: <br /> ❑ Three compartment sink- <br /> OR <br /> ® Three deep 105 (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 /> ® Datergent, bleach,and wiping cloths(deaning tovfels). <br /> ❑Tub to store►viping cloths In bleach solution. <br /> 12- 1 am providing the following ►or adequate hand washing facilities. but separatn from utensil wash within my <br /> booth. <br /> ®Water supply dispenser with warm water at a minimum of 100"F(i.e. 5-20 gnilon container with spigot) <br /> ® One separate tub(bucket or basin)for the eotlectiorl of rinseMastawater. <br /> ® Paper talents and pumo-sty%soap container. <br /> 13. Names of fesponwb$e persons to be present in booth during al hours of operation_ <br /> Jesus&Carmen Solis <br /> "Important" All food vendor booths am subject to inspection. Please make a copy of this applicatlon in <br /> pteparatian for this event A copy of this checklist must be In the booth at all hours of <br /> preparation and operatlon. Return originplAo f9stW1 coordlinotgr throe weeks y6or to <br /> this event. <br /> 14. Completed by: <br /> 5/14/25 <br /> re Title Date <br /> sb or <br /> Health f'ermft wrd.a.h'A'A. <br /> Ns'a rCr.dtry <br /> p.n <br /> •psr Fiusr Tc..r <br /> Su.P d.t+wz"R <br /> s,n�nr euatl <br /> bwah A.19.ro <br /> R'-cons 6+jrr I �k�y ���s'V dah <br /> Bmtrl roust be on <br /> eomete.Aral-wt. <br /> Plywood.or a Tarp. <br /> nncsr rrk <br /> Eip uv'Tlu F+"w Wslw EenT aex 'R'wr Gaftlege <br /> s'n ErfryVu� <br /> can <br /> ECi <br /> k11 f," <br /> Ice Coder i 5 f„i FUW mow <br /> Dam a:r 8ys A Fwa C-�Wwwx nw is WaNwMer COnLrrr <br /> atial 1 rW�nT rf]MY p-M&W <br /> DID 16M Peg•4 d 11 TF%IP EVLWT APP <br /> cW11e <br />