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03-07-19;04:29PM;#3/7 <br />i <br />8. <br />fl. <br />OR <br />VMer supply dispenserwRh warm wawr Ma minimum of lOO'F (l.e, 5-20 gallon container wtm spigot). <br />11 <br />“important” <br />Completed Byr <br />Signature <br />Health Permit <br />^Mariiiii^is'i <br />( <br />DMTi <br />AV VMM <br />/ <br />r'^l U2 <br />WM3«WC0’WMf <br />10. <br />I <br />I am providing the following cold tamparatura control for the cold holding of potentially hazardous foods below <br />45*F (If food la used th* fotowfog day, maintain below 41’F temperature): <br />□ Ira chests <br />□ Refrigerated truck <br />O Other (*pedfy)__ <br />«a£S f> toMMowT frv <br />SMtf 0 heati aBdtatn** <br />□ one separate tub (bucket or basin) for th* coHodlon of rtosc/westcwater. <br />□ Paper towels end oump-styta soao container. <br />KmWXMng <br />Ow <br />£1 Refrigerator <br />□ loe bath and tubs <br />Sooth nunt b» on <br />ConcrM, AAphM, <br />Rywood. «e ■ Tarp. <br />[ Ice Cooler 1'1 <br />I______V <br />I am provitfng the following items within my booth for the sanitary cleaning of food preparMion utensils: <br />^3 Three compartment sink. <br />□ Three deep tubs (basins 6-8 Inches mrtmuni), one far soapy waler, one for rinsing and one tor a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />X? Detergent bleach, and wiping doma (deanlng towels), <br />O Tub to store wiping doths in bleach solution. <br />I am providing the foUowfng for adequate hand washing facilities, but separate from utensil wash within my <br />Booth: <br />Qvt)«o« . <br />C*r» <br />MMDliwtarta* <br />asnnQvprpcuea <br />Dfltv <br />nl <br />r i <br />-^■--7--..... <br />Naina* of raaponaibte persons to be present In booth during ell hours of operation: <br />AntqM.Q <br />AB food v*ndor booths are subject to inspection. Plane make e copy of this eppbcetion In <br />preparation for this event. A copy of this checMist must be In the booth at M houra of <br />preparadon and operation. Return orfalnsl to fMtfrll OOOrdlnMor th!W waMfo Pffof to <br />1 r Vseneewm <br />Q <br />Tttf* <br />Moca, <br />r- NxMMarWAM