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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 OF temperature): <br /> Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) �l <br /> 11. 1 am providing the following items within my booth for warewashing: �J" �✓ <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 /> 12. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> ❑ Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br /> ✓A'" 6101 K -S 0-15TAvALA�N-->-r #1 f l2 19j <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 pump-style soap <br /> container. <br /> 14. Names of responsible persons to be present in booth d ring hours of operation:. i ae es �, ` <br /> serve : -1 f <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 /> 15. Completed by: H;to <br /> Signature Title Date <br /> 1, _.•._--.,._ :-•�� 5-26 Gal. <br /> Health Permit Hand wash Water <br /> — <br /> Health wrChaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Gutting Board Sanitizer Isuckel- <br /> tllearh 8 water for <br /> Propane 51ove aBleach <br /> storing wiping cloths <br /> Booth must be on <br /> 0 Concrete,Asphalt, <br /> Plywood, or a Tarp. <br /> Propane Tank <br /> Soap antl WalarWater Garbage <br /> "- Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> Ice Cooled 5 Gal Hand wash <br /> I Extra Ice Hags B Food Conta hers must be Wastewater container <br /> ----------------- stored 6inchesoffolrhegroundr 1-1 <br /> EHD 16-02 Page 8 of 11 TEMP EVENT APP <br /> 7114115 <br />