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10. I 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 41T temperature): <br />I am providing the following items within my booth for warewashing:11. <br />OR <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />“Important" <br />15. <br />[ Health Permit » <br />Paper Hand To*«4a <br />I CutingBovd I <br />ffwth Propane Stova <br />Ice Cooter <br />P«s« B of 11 TEMP EVENT AFP <br />o^ne< <br />Title <br />EHO 15-02 <br />7/14/15 <br />Sumo wfChaffing <br />Dirt <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gai Hand wash <br />Wanwwaiar Cortamr <br />5-20 Gal <br />Hand wart Water <br />Booth must ba on <br />Concrete. Asphalt, <br />Plywood, oraTaip- <br />0 Ice chests <br />□ Refrigerated truck <br />□ Other (spedty) <br />Garbage <br />Can <br />SanrttxertxjdsM- <br />bteartt water tar <br />etefins wiping ctadis <br />□ Three compartment sink. <br />/Ej Three deep tubs (basins 6-a 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 />IBA.. <br /> <br />| Propane Tank <br />1Z I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Detergent, bleach, wiping cloths (claaning towels), and a tub to store wiping cloths in bleach solution. <br />Fn Brtiguishar | <br />Date <br />CrnAteAagxd AMtfCDMMteninusffM f l <br />gtorvtif Mtt otf of thagmunil U <br />XJ Water supply dispenser with warm water at a minimum of 100’F (Le. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pymp-stvle soap <br />container. <br />SwfMdWW I <br />| SMuawme, | .......... <br />I Sowvawaar I Rima <br />Names of responsible^ersons^o be pns^Hn booth during all hours of operation: <br />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 this event <br />Completed <br />Signature