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8 <br />8.I am providing the follwMng tenw within my booth fw the mntfwy cleaning of food preparation utensils: <br />□ fhrae compannwot sink. <br />OH <br />□ Detergent, bleach, and wiping ctofhs (deenlng tawote) <br />□ Tub to store wiping dotha m bteach scHubon. <br />10. <br />□ V\tetef supply diapensef with wwnt water st e minimum of 100*F (l.e. 5-20 gallon container with •pigot). <br />O Ctoe separate tut (bucket or beam) for the cottection of rinse/wastewater. <br />□ Paper towels and puptoWtewep container. <br />fsent in booth during all hours ©f opwitton.13. <br />“Important** <br />Completed by:14. <br />Health Permit <br />PtOarnaMTiarfl* <br />PMAwSam <br />£ <br />11 •rewn evtMT app <br />?0W 04 12 17:24 Page 3/3 <br />cxnMM <br />IXMl ft vwr M <br />drtifwMifdNtft <br />Title <br />EHD t««l <br />1W1WI <br />8«v<ww<nMflk>o <br />Dkh <br />BGeHandM* wmwcwar* <br />O Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />QRefWgeratDr <br />□ ice Mh and tube <br />Bao*i must tn on <br />Conereto. Aiphiit <br />Plywood, or a Tarp. <br />Garbage <br />Cm <br />I am providing the foltowing for adequate hand washing fedUbee, but separate from utensil wash within my <br />booth: <br />y-/A/6 <br />a«u> <br />£*» »»a^« ft »-•-»*» <br />tfwW » Mt f*» FMt <br />...> pre 80 nt in booth during all hours of operation. <br />_______________ <br />All food vendor booths are subject to irrapocUon. Please mate a copy of this appMcatton in <br />preparation for this event A copy of this checklist must be In the booth A all hours of <br />prepersbon and operation. Return ortolnsl to teethral coorxHnator three weeks Prior to <br />shfeuant <br />L*'’**'*j <br />6^0 Ml <br />r- HBidwwtiWftK <br />’n\ <br />I am providing the foHcrwmg cold tmuperature control for tha cold holding of potentirty —atoous foods below <br />46*F (If food is used the fobowfng day, maintain betaw 41 »F temperature). <br />□ Three deep tubs (baeins M inches minirnum). one tar soapy water, one for nrremg and one for a bleach <br />solution (one taU&spoOn of bleach per gator, of water). <br />Names of responaibte persons to be <br />i T«r* j -I--'"-. <br />W (az <br />j Ice Cooler t;.J <br />i! BoftftMWaaw || RM>VUh« | ywnwWw