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07-21-2017 08:47 PODESTOS 39518601 PAGE2 <br />10. <br />11. <br />OR <br />12. <br />;■ <br />14.Competed by: nns© <br />Health Permit <br />Stomo <br />Hand TtavM* <br />SMeMeonav <br />!. <br />PNMnaTaa* <br />i 9U0WW*■ia-d.mwator <br />Hvnt!ahiaiJalw | <br />Avr «!«*M or^aha <br />PaoMtfll ■reMOEvsffAW!. <br />I r <br />EHD 1*42 <br />WTO VU <br />I am providing the following items within my booth fbr the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />O Refrigerator <br />□ Ice bath and tubs <br />SOfliHtMMtti <br />WatawtarCtnttw <br />SMMartv^ <br />umhlintarfer <br />rtrrinj wiping <br />! <br />f <br />! <br />i- <br />r <br />! <br />□ Water supply dispenser with warm water at a minimum of 100T (i e. 5-20 gdlon container with spigot) <br />□ One separate tub (bucket or basin) far the collectton of rinsa/wastewater. <br />r <br />I <br />!' <br />f <br />Allfo^r J ’ ‘ <br />preparation for this event. <br />raeoiK <br />£*>*>avi«rso«CinMwniH4f»* B <br />tKAaa «rfAa (a™* ■ <br /> r T'T'^MnteswZr <br />□ Detergent, bleach, and wiping cfoths (cleaning towels). <br />^Cj^Tub to store wiping cloths in bleach solution. <br />I^m providing (be following far adequate hand washing facilities, but separate ffom utensH wash within my <br />| BHMl <br />WwW^r J <br />/O\I Water I <br />Rjatiboterl <br />O^Jloe chests <br />□ Refrigerated truck <br />□ other (specify] <br />. i . <br />Boom must be on <br />Concrote, AsphWt. <br />Plywood, <r a Twp, <br />| cuwigeMJ <br />A copy of this checklist must be In the booth at all hours of <br />Return orfainal to fertlyaf coordinator three weeks prior to <br />13 Tr^T9r^l5L,r1n9 0,1 pperartton: <br />---------- <br />",mPort™rt" AH fodl vendor booths are subject to Inspection, Please make ecopy of this appiicatjon in <br />and