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2 jpg3/12/2018 <br />8. <br />9. <br />OR <br />10. <br />K <br />13.Names of responsible <br />"Important" <br />14.Completed <br />Signature <br />TEM?>EVEMT <br />VIhttps://mail.google.com/mail/ca/u/0/#inbox/1604e532ac032677?projector=l£messagePartld=0.5 <br />A' <br />TBe <br />□ Water supply dispenser with warm water at a minimum of 100’F (te. 5-20 gallon container with spigot) <br />□ One separate tub (buckrt or basin) for the coBection of rinsehrastewater <br />□ Refrigerator <br />□ Ice bath and tubs <br />Garbage <br />Can <br />"" ’— <br />Booth must be on <br />Concrete. Ajphax <br />Plywood, ora Taip. <br />i <br />EHD 164® <br />5 a G;.’ <br />HncmtiTxjr <br />I currsflearj | <br />Frcxu. < Six-J | _ <br />I am providing the fotowwg items within my booth far the unitary cleaning at food prepantflon uternfe: <br />fi^Three compartment sink. <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />Health Permit 11 <br />. tUyWCEEtuiiUji <br />/ I I I ■wwiai- ~| | wnscr ~j | toaeavaj"! [ I <br />-j'-—-I Q <br />Ice Cooler i ■ w <br />..._______ f| uJt/Mcfax;c.‘'s'|/«xccj I- | <br />All faod venaartooea are si^ectto r^ectZ nLta a cam m <br />Acopy of fate Cheofet must be in the booth a at hows of <br />preparatKm and operabon Return prjgiMt to festhml coordinator three weeks prior to <br />AHSr.ysgtK; <br />Date ' <br />□ ice chests <br />^Refrigerated track <br />□ Other (soecify) <br />$r‘^rhc-<j