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ivial, }, LVI / IL:j�YIVI <br /> No, 0359 P. <br /> 10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45T(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 /> OR ElThree compartment sink. <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 /> ❑Water supply dispenser with warm water at a minimum of I001(i.e. 5-20 gallon container with spigot)" <br /> 011 One separate tub (bucket or basin)for the collection of rinse/wastewater" <br /> '❑\Paper towels and pump-style soap container. <br /> 13. Names of res onsible p s ns to be resent in booth during all hours of operation: <br /> �9 /�l C�Goc <br /> "Important"' All food vendor booths are subject to inspection. Please make s 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 fe$tival coordinator three weeks prior to <br /> this 4"nt, <br /> 14. Completed by; <br /> ignature L Title Date <br /> Health Permit <br /> StetnD w/Grn®rrng Hand wash Water <br /> 11sh <br /> Paper Mand Towels <br /> Soap CiaDanser <br /> CNGng Board <br /> Senitlzer buMet- <br /> Propene StDve blear&water for <br /> Bleach storing w1ping cloths <br /> ' Hoolh must 6e on <br /> Concrete,Asphalt, <br /> Propane Tenk <br /> st'"�2r_......_' 'r N•'jf„.t�J'i'.:;�� _1 �_y•.v_t .L Y .,.;> <br /> y <br /> Soap and Water Rine Water Bleach end Water <br /> Garbage <br /> Fire Extinguisher Can <br /> Ice Cooler >. <br /> n5, B GaI Hand wash <br /> Extra 10 Bags d Food Contalners must be Waslawaler container <br /> Stored G Inches Of Of the gnwndt <br /> EHD is-o2 Page 8 of 11 <br /> 08/01/16 9 TEMP EVENT APP <br />