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Ub ad 14Dec.PhfcJrrT^UlNCL LHNShN HM1NI1NU bbKUlCtC <br />10. <br />11. <br />OR <br />12. <br />13. <br />••Important** <br />Re <br />Completed by: 14. <br />Health Permit I <br />PrtXMM Stow* <br />It <br />Pzopana Tar* <br />JI etMC.*! wvj tfrttw <br />CxI rxHrtXWf <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />t <br />1 <br />II <br />EHO 16-02 <br />7/29/10 <br />Stomo w.Vwfl’ng <br />DWi <br />^’Refrigerator <br />□ Ice bath and tubs <br />SGWfWnOwXi <br />'NeslowaMr Conlanor <br />5-20 QaL <br />Hand woanWom <br />Date' <br />Gartwge <br />Can <br />Title <br />Booth must bo on <br />Concrete. AtphaR, <br />Ptywcwt, or a Tarp. <br />/ <br />FWtMWrtw <br />Ears \ <br />n/w«> | <br />__L <br />SMpaAdW*1*r <br />12^06 Chests <br />QK^efrigerated truck <br />□ Other (specify) <br />I am providing the following items within my booth for the sanitaiy deaning of food preparation utensils: <br />G*» /ca 8spi a Fotnl Containers must be <br />slcrtf 6 Inches Off ro grovnm <br />washing facilities, but separate from utensil wash within my <br />Sgaoapponsw I —1 ’ <br />“J <br />01 hree compartment sink. <br />a^Three deep tubs (basrns 6-8 inches m.nimum), one for soapy water, one for rinsmg and one tor a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />©detergent, bleach, and wiping cloths (cleaning towels). <br />©Tubto store wiping cloths in bleach solution. <br />I am providing the following for adequate hand <br />booth: <br />l^ier supply dispenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot). <br />EKfai separate tub (bucket or basin) for the collection of rinse/wastewater. <br />{^Faper towels and pump-stvle soap container. <br />Aii 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 afl hours of <br />pre^ratiofi) and operation Return original. 10 Wlvpl coordinator three prior to <br />this event/ <br />[ CKDIM) Gocml | <br />Sigpdture <br />t-HX nu. : 4bbb4^4