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i0. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45°F(if food is used the followirig day;maintain below 41°F temperature): Not Applicable <br /> ❑ Ice chests ❑Refrigerator <br /> ❑ Refrigerated truck ❑Ice bath and tabs <br /> ❑Other(specify) <br /> 11. I am providing the following items within my booth for warewashjng: <br /> ❑Three compartmentsink- <br /> OR <br /> 12 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 /> 12_ 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils- <br /> Detergent, bleach, wiping elotns(cleaning towels),and a tub to store wiping cloths in bleach solution_ <br /> 13. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br /> ®Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot)_ A <br /> separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a purn , le. soao <br /> container_ <br /> 14. Names of respersible persons to be present in booth during.all hours of operation: <br /> Vince Truong <br /> **lmportant" 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. Retum original to.festival coordinator three weeks prior to <br /> +.this event <br /> 15. Completed by; 7�/—,� Owner 8i29/16 <br /> Signature Title Date <br /> s-zo cap. <br /> Health Permit Mond wE6h WalRr <br /> Siaxrw wlChaffirtg <br /> Dish <br /> Paper}iand Towels <br /> Soao daapzser <br /> GutL'ng Board <br /> 3ani6zFr 6 <br /> blearh&wafer Yor <br /> Proyane Save glee`}, etodng wpog ctmu <br /> BOO;h fi1USt f'f8 flfl <br /> Concrete,AsphalC <br /> �� � � Plywood,or a Tarp. <br /> Prpl;ane Tank :7: r, <br /> .. �r^a-•i:i'v�i-:;. "ire ,C �^ <br /> Soap and Water RUue Waler $fcaGr and ylaler <br /> Garbage <br /> tiL+ ;*l. Fre 6nlnaulehar Can <br /> �": '• Extra <br /> tsri <br /> -f, <br /> Ice Cooler ;'S S Gal rand wash <br /> P.Arr les Zags&Food.Conreinars Host 5s 'Nasiewaler Canraln�r <br /> stored 6 fnelrss of'ar/he ground! <br /> EHD 15-92 PzG g of 11 <br /> 7r.4n s TEMP EVE47 pPP <br />