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10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45°F(if food is used the following day,maintain below 41'F temperature): <br /> ❑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 /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> rOne <br /> tersupplydispenser with warm water at a minimum of 100°F(i.e.5-20 gallon container with spigot). <br /> separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> PPaper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> It 1 A ot&lr c� <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: <br /> igna#ure Title Div ctjW Date <br /> Gal. <br /> Health Permit F-Y,,'as?i Water <br /> Sterro w9Chafrvg <br /> Dish <br /> Paper Hand Torels <br /> Soap dispenser <br /> Culling Bozrd Saritaer Iw&eI- <br /> bleach&waterlor <br /> Propan0 Stove Bleach storing wiping cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> 1 -e ' Can <br /> rtre EMirgusher <br /> MR <br /> �: Wafer <br /> Ice Cooler u <br /> 5 Gal Hand wash <br /> Extra Ice Sags S Food Conra/ners must be Wastewalcr Container <br /> stored sInches 0ffC fhe groura! <br /> EHD 16.02 Page 8 of 11 <br /> 7128/10 TEMP EVENT APP <br />