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S A N 10 A U 1.l 1 N Environmental Health Department <br /> 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 457(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) SELF CONTAINED CART <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> ❑Three compartment sink <br /> OR <br /> El Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a oleach <br /> solution(one tablespoon of bleach per gallon of water). <br /> 0 Detergent. bleach, and wiping cloths(cleaning rowels). <br /> 0 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 /> r 0 Ilk <br /> Water supply dispenser with warm water at a minimum of 100"F(i.e 5-20 gallon container with spigot). <br /> 0 One separate tub(bucket or basin)for the collection of rinse/wastewater. <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 /> ZACHARY BRADSHAW ROSE BRADSHAW <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 operatii Return original to festival coordinator three weeks prior to <br /> this eve <br /> 14. Completed by: 4 U w,,wc''r; S -�:- ___� <br /> nature Title Date <br /> � s-zo Gal <br /> Health Permit "'n0"'°"" '°' <br /> Stoma wlGMfinp - <br /> aw <br /> Pww Maid T&"* <br /> S4a0 tl+sponsor a <br /> txiUal- <br /> Dlp�S wt♦r br yO <br /> --,�; n St.�✓e BseaCn �^aG wtp+r^0 tlettfa <br /> Booth must be on r <br /> Concrete.Asphalt, <br /> Ptywood,or a Tarp. <br /> Pragry r.w - t <br /> ':. +auU'Nazar N,nsa Water Ime;r..r,a,i�'raiw 487tia" <br /> Can . a <br /> F�ra F,n na�istwr <br /> W�1sr <br />