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10. <br />I an providaig the kjlicwing items within my booth for WBnewashirng.11 <br />I-1 Three oomparlmRnt sink. <br />DR <br />1? <br />13 <br />14 <br />' Important' <br />Curripieteci by15. <br />I lealfli Permit <br />F <br />Irik /Mhi <br />• it <br />11’ Mi P.PN r AMP <br />I Ice Cooler <br />i <br />fldflwX Vi-xn <br />Uuucn £. *ww -Vi- <br />*>**4 - *iJi^ <br />I gm prtwiding Itw following COlri temperature control for the cold holding of pplentially fauafdou* foods toefow <br />45^ (if food used the following day, maintain below 41 'F tL-nipufature}' <br />n Refrigerator <br />|_J Ice bath and fobs <br /> <br />I chests <br />□ Refrigerated truck <br />[ ] Other (specify) <br />[^Three deep tubs (bar&ms 6 A inches minimum j. one for soapy watm, one for rinsing arid One for a bleach <br />solution (unu tatole&pwn of bleach per gallon of waler) <br />Gaibane <br />Cup <br />Names of luspiXiSibfo persens Io be piCSOnt in booth dunng all hours qf operatwn.V\<? aa. ~ Vxx ~ X________________________ <br />I am providing the following items within nly booth fry the sanitary clcanwij of food preparation utensils’ <br />[iprfefergent. bleach, wiping cloths (cleaning towels), and a tub to slu«e wiping r.fcths in bloaCh solution <br />*. ;i; i ni <br />I am providing thrr following for adequate hand washing facilities, but separate fmm uterisul wash within my boofh. <br />[yV^teter supply dispenser with warm water al a minrnum oi IGO' I (i.e 5 gallcn container with spigot). A <br />separate tub (bucket or basin) (or the collodion of rinseAwastewater Paper towefe arid 3 pump-style soap <br />conlainu. <br />J-’Jn -■m:i,vmd- <br />41C.|l|>A(r¥'-'.ZMH-M- j <br />I <br />Knrrlh rjusl lit 00 <br />ConcncrlR. Asplicill, <br />Ffywwd OTA Iwp <br />□ata * <br />gal-9 VVI /Lv^K A 1 aFJll ■ <br />|V Mw iflirtW" H <br />All food vendor booths are subjer-t to inspection Please make a copy of this application ih <br />preparatfon for this event A copy ol this checklist must be m the booth at all hours of <br />preparation and operation. HUturp original Io fwUMQl ccordtnator |hrCQ yrgekfl prfor fo <br />Oily event. <br />Jz <br />Signature <br />. IrOT'CI MK.lljn*4 <br />.yy* <br />£7~U ■/vli-'X <br />Title <br />1 Oil rn nurl