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10. 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 following day,maintain below 41 OF 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 providina the followina 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 100'F(i.e. 5-20 gallon container with spigot). <br /> ❑One separate tub (bucket or basin)for the collection of rinse/wastewater. <br /> ❑ Paper towels and dump-style soap container. <br /> 13. Names of rensibliq pe ons to present in booth during all hours of operation: <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: t,l/!'1!1/� f <br /> ignature Title Date <br /> 5-2c Gat. <br /> Health Per Hand wash Water <br /> Stern.wtiheRng <br /> fish <br /> Paper Hand Trn+re15 <br /> Soap dispenser <br /> cutting Board S"Aimr bucket- <br /> bleach i&water`or <br /> Propane Sbve gg staring`+.Iping tl Dths <br /> Booth must b�h. <br /> n <br /> Concrete,Ast, <br /> Plywood,orae. <br /> Propane Tank <br /> -�:— Saap and Water Rinse Waler Bleach and Water Garbage <br /> can <br /> Firs Ectinpuisher <br /> Extra <br /> YSra(er <br /> Ice Choler 5 Gel Hand weah <br /> Extra Ice Bags 8 Food Contelne/5 must be Wastewater container <br /> '— - slorad6fnches o1ro7Me ground! <br /> EHD 16-02 Page 8 01 11 TEMP EVENT APP <br /> 728/10 <br /> d x',17(17-/RQ-Fn7 nn i inivn�tnv�i i d <br />