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' <br /> / <br /> / <br /> � <br /> � 8 &] ��� � ��f &� <br /> ���|� JK�������� Environmental Health Departrxe,,,nt <br /> 10. | 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°F1emperatum): <br /> '010 chests F1Refrigara0m <br /> Refrigerated truck E] Ice bath and tubs <br /> Other(specify) <br /> 11. | providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> L�f,Thnna compartment sink. <br /> OR ' <br /> ;Orthree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for Wumuh <br /> solption (one tablespoon of bleach per gallon of water). <br /> NfEwerg*nt, o/eaon.and wiping cloths(cleaning 8owe|e). <br /> I]W|uuto store vvipinQc|otheinb(eaohoo|uhon. <br /> 12. / am providing the following for adequate hand washing faui{iUoo, but separate from utensil wash within my <br /> booth: '^ <br /> UlWater supply dispenser with warm water at a minimum of 1007(i.e.5-20 gallon container with spigot). <br /> separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> QRpoper towels and container. <br /> 13. Names of responsible <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 o n. Return original to festival coordinator three weeks PEi:_or to <br /> this event. <br /> 14. Completed by: <br /> Signature Title Date <br /> Health Permit-] Sterno w/Chaffir.9 Hand-ma."Water <br /> Dish <br /> Bleach Storlm,WiPiN cloths <br /> ,L:jb 0 <br /> Soap and Water Rim. Water 81..ch mnd Wate7r <br /> Garbage <br /> Can <br /> Oil <br /> Li <br /> L�Rlns. W.IrL <br /> "Joth] <br /> Ice Cooler 5 Gal Hand wasli <br /> In0u UmznKonAvenun I 5h/ckkon. Ce|�unnie@520� } T 208488-3420 / F 209464-013$ | www'pU /nhd <br /> p°qeoof I I TEMP eVQwrApp <br />