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Mar. 4. 2016 12:58 PM GHIRARDELLI No. 2854 P. 27 <br />io. <br />OR <br />12. <br />wash within my <br />13.Names of responsible persons to be present in booth during all hours of operation: <br /> <br />important** <br />14.Completed by: <br /> SignatureTitle <br />Papnr Hand Towels <br />CmllAg Bo^rd <br />Prokina 5(OV9 Bleach <br />Propane Tank <br />Fire ExifngulBher <br />P^e 3 of 11 <br />TEMP EVENT APP <br />4. 2016 12:50 PM No. 0539 <br />a* <br />EHD 10-02 <br />•J1Z4/14 <br /> Refrigerator <br /> Ice bath and tubs <br />Btra <br />Wafer <br />5-20 Gal. <br />Hand wash Wofor <br />Garbage <br />Can <br />blg&oh & vvstof for <br />storing wiping ctolhs <br /> Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />3 <br />Health Permit <br />Date <br />All food vendor booths are <br />preparation for this event, <br />preparation and operation. <br />this evant <br />5 Gal Hand I <br />WasiswaferGcminer <br />.4W <br />z:.......:2....... <br />Ice Cooler 1 r <br />Starno w/ChafTJng <br />Dish <br />subject to inspection. Please make a copy of this application in <br />A copy of this checklist must be in the booth at all hours of <br />.Return priqtnaj to fostival coordinator three weeks prior to <br />SJbXXspS for SMpy 'TOter-onG ,,"s'"3 and onG for a “”ch <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Test strips to measure sanitation levels for bleach solution measuring 10Oppm. <br /> Tub to store wiping cloths in bleach solution measuring lOOppm. <br />I^am providing the following for adequate hand washing facilities, but separate from utensil <br />Received Time Mar. <br />S. Conlainans wst be I <br />stoied b Maa alfot Vie gwodi I ;• <br />F Soap dlspcnftftr I . <br />' the C0,d temPsrature control for the cold holding of potentially hazardous foods below <br />45 F (if food is used the following day, maintain below 41 °F temperature): <br />Fl Ice chests <br />O Refrigerated track <br />L] Other (specify) <br />11- lam providing the following items within my booth for the sanitary cleaning of food preparation utensils; <br />D Three compartment sink. <br />Soap md Waler Rln!8 Water Bleach and Water I | <br />.-------------- ------— <br />Booth must be on <br />Concrele, Asphalt, <br />Plywood, or a Tarp.