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10, <br />I am prowdirjg the lotowing items withn my booth for the sanitary clean'ng of Food preparabon utensils:11. <br />^Tivee compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping dotns in bleach soiirtm. <br />12. <br />Water supply dispenser with warm waler at a minimum of 100’F (i.e. 5-20 gallon container with spsgot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style sow container. <br />13. <br />"Important" <br />this <br />ki Ln,Completed by:14. <br />Health Permit <br />H»nc r=w<i <br />8c»pi»e»-tw <br />*••<71Pn^ara 3tnw <br />T«* <br />• ir«0 <br />Ice Cooler <br />rtvPE/Err aop51 <br />I am prowding the failowing tor adecuate hand washing Wilies. but separate from utensil wash within my <br />booth: <br />□ Three deep tubs (basins 6-6 inches minimum), one for soapy water, one for rinsing and ere to' a bleach <br />so'ution (one tablespoon pf bleach per gallon of waler). <br />I am providing the fcltow.ng ood temperature control for the cold holding of potentially hazardous feeds beow <br />4§-'F (if food is used the follow ng day, mantain below 41 °F temperature): <br />5x-i.su buOaC- <br />aaarfcr <br />•**-<*S w v«j e»*M <br />EHD‘a-€G <br />rare <br />□ fee chests <br />□ Refngerated truck <br />[3Other (specify) <br />R»™ aCTuhng <br />Dwi <br />SOwMaMAwr. <br />Ccrtww- <br />>50 Oal <br />"iTW-'-AVr <br />Booth rruiif be on <br />Coro'&ie. Aspr^r <br />PJ/womS. er a Tan> <br />Date <br />I <br />Jcxp.reV.alw- <br />Names of response persons to be present m booth during e9 hours of eperaton: <br />H.KAt, S> ______C? ra-f <_ Q-Tr-x.aA v X_________________________________. . - <br />Ab food venoc*' booths are subjed to inspection. Please make a copy of thss application In <br />preparation for this event. A ccpy of this checklist must be in the booth at a:i hours of <br />preparaDon and operation. Return original to festival coordinator three weeks prior to <br />mt. <br />“'“signature <br />Q \ A c/sA <br />Thie <br />Can <br />□ Refrigerator <br />□ toe bath and tubs <br />Uo'-U. <br />I Hi <br />_z_, <br />hn» WtU. I