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7#7/03-07-19;04:29PM; <br />8. <br />9. <br />OR <br />10. <br />13. <br />—Importanr* <br />14.Completed by; <br />Signature Title Date <br />Health Permit <br />I c ■*< <br />u <br />Ice Cooler * <br />P«Qw 0 al n TEMP EVENT AFP <br />I am providing the following items within my booth for the sanitary deanlng of food preparation utensils: <br />Qjhree compartment sink. <br />EHD IMi <br />itvisrog <br />2J4ca chests <br />O Refrigerated truck <br />□ Other (specify) <br />^JTtefrigerator <br />□ Ice bath and tubs <br />□ Water supply dispenser with warm water at a minimum of 10O’F (l.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Slnj*Ch«*R8 <br />Ou* <br />responsible <br />Hand 4 txhtf oif a/ ■ <br />BarWwtxrtii, <br />N«Mh&WMVf» <br />■lotngw^nadotfw <br />&(MMand*Mn <br />Qprjt^w <br />3^ <br />—Booth must be on <br />Conovto, Aephelt, <br />Pfywood, or a Tarp, <br />□ Three deep tubs (basins 6-6 Inches minimum), one for soapy water, one for rinsing and one ter a bleach <br />solubon (one tablespoon of bleach per gallon of water). <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths In bleach solution. <br />Prav'dig ^6 following cold temperature control far the cold holding of potentially hazardous foods below <br />45 F (If food Is used the following day, maintain below 41 ‘F temperature); <br />Gprtwge <br />Can <br />□ Paper lowelg and pymp-styfe soap container. <br /> »to be^ea^t fa^bt^thdtfirig.a!l hourpryfoperatlon^ <br />All food vendor booths ere subject to inspection. Please make a copy of this application In <br />preparation ter this event A copy of this checklist must ba In the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks nrior to <br />this event, -------- “ <br />3Z <br />MD QM. <br />I | __ \ <br />lam providing the following for adequate hand washing faculties, but separate from utensil wash within mv <br />booth: 7 <br />j r <br />A