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10 I am providing the foilowictg cold temperature control for the cold holding of potentially hazardous foods belevr <br /> 45`F(if food is used the foilowing day,maintain below 41°F temperature): <br /> —215e chests ❑Refriigerator <br /> I]Refrigerated truck ve bath and tubs <br /> E,Other(specify) <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> ❑Three compartment sink. <br /> OR <br /> O-Tl�ree deep tubs (basins 6-8 inches mirimum), one for soapy water, one for rinsing and one for a bleach <br /> solution(one tablespoon of bleach per gallon of water) <br /> .�etergent, bleach,and wiping cloths(cleaning towels;. <br /> est strips to measure sanitation levels for bleach solution measuring 100ppm. <br /> L7 Tub to store wiping cloths in bleach solution measuring 100ppm. <br /> 12. 1 am providing tr e following for adequate hand washing fac(!Jes. but Separate from utensil wash within my <br /> booth <br /> „L7;-V0ater supply dispenser with warm water at a minimum of 1001F q.e. 5-20 gallon�container with spigot). <br /> ,,C3 a separate tub(bucket or basin)for the co!iectior of rinse/,&astetirrater. <br /> ,L>raper towels and-pump-style soap container. <br /> 13 Names of responsible persons to be present in booth during all hours of operation: <br /> V\. Qn Vk ta <br /> toa _ <br /> —Important*" All food vendor booths are subject to inspection. Please make a copy of this apa!icatiDr. :n <br /> preparation for this event. A copy of this check!!st T;;st be in the booth at of L--; rs o` <br /> Dreparation and operation. Return original to festival coordinator three weeks prior to <br /> this event. r <br /> 14. Completed by: D siC � <br /> gnature u Title Date <br /> Health Permi? HancassrWwr <br /> Steno a'Gra'h„ ' \ <br /> SOLE=:fi'.ea3Y \ - . 1 <br /> �:Gorg 9aa� \ <br /> oOciL.0r4crc<e: � <br /> piea718 waterier <br /> P�4DnC S:ON E'ea_F itonna wiping cZl <br /> Booth must be on <br /> - Concrete.Asphalt. <br /> PWOou.or a Tarp. <br /> ) I i <br /> Garbage <br /> -,�=r. •a�:,�r Can <br /> e'. L <br /> lce Cooler <br /> s cap r-ar,tl warn <br /> _rlr s dais S F;oo Ca�raners -..:cr ae :;ast�vatcr nor;y-w <br /> a <br /> „�.�. re2._ of t l BEM?EVENT:.ap <br />