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9 r l ; <br /> ._ fl � �1.�l �� i e Environmental Health Department <br /> 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 /> 0 Ice chests ❑ Refrigerator <br /> ❑Refrigerated truck ❑ Ice bath and tubs <br /> Other <br /> 11. 1 am providing the following items wit i 7/7 th for the sanitary cleaning of food preparation utensil <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 wilhin my <br /> booth: <br /> ❑Water supply dispenser with warm water ata minimum of 100"F(i.e.5-20 gallon container with spigot). <br /> ❑ One separate tub(bucket or basin)for the collection of drisefwastewater <br /> ❑ Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> 4,l. <br /> "Important" All food vendor booties 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. Rektrn priginal to festival coordinator three weeks prior to <br /> this even <br /> 14. Completed by: <br /> ignature Title Date <br /> S"0 C. <br /> Health F�ermitE - wI'llY el <br /> S:nrnn yur <br /> I <br /> or"'-E] ,:�L4:f 14xM ruFbta <br /> r:unnxl Hnvd ..... <br /> :a'wr<er WE hot <br /> Ifi:reh R w.11rr hx <br /> Prypanr Slane —i3+ra:h— nan.+r wa.q,raar <br /> Boolli muss be on <br /> Concrele,Asphalt. <br /> Plywood.w a Yarp. <br /> r+rr.�urTart <br /> Sn.nr <br /> .1 1"• Rmv iW;rrr R;rnsn r n dVda Garlrage <br /> Can <br /> Far.!.rbc+qnsr,rr <br /> li.h.t <br /> Ice Cooler <br /> rr4a ren Q.rys A f ne.f L'�rrinnu•ra ru,nr ee: An•rew.nw C;ar,plmr• <br /> afnrcd a nwhra ad nt Nm yreNner <br /> :t <br /> :d]-^ 1= "1:3tea;,tl, -ir I!t—. 'j'rir,k }rl .lti ,.•� .�a :Ili ,.�: l l <br /> l 1 iri....,,.rh ti.r:::ilrel3d.ct)It <br /> EHU Ifi-02 v rqe Y.[d 91 rEmp EVEN r P&P <br /> 'a,1; <br />