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t � 1 <br /> e <br /> I am p-oviding the following cold ;temperature control for the cold holding of pctenrto.,y hazardous foods belo,,, <br /> i.5`1` (if fcod is used the following day, maintain belc:. 41 T temperature): <br /> 4,1ce c1.ests dRef r,aerator <br /> ❑Refrigerated truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11. I,am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> �e N 1 hree compartment sink VAIri <br /> OR <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> �t7 solution (one tablespoon of bleach per gallon of water) <br /> (}Detergent, bleach, and wiping cloths(cleaning towels). <br /> Ev"'Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br /> Tub to store wiping cloths in bleach solution measuring 100ppm. <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth' <br /> ❑water supply dispenser with warm water at a minimum of 1007(i.e. 8-20 gallon container with spigot). <br /> [ One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> 4aper towels and pump-style soao container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> *Important" All food vendor booths are subject to inspection. Please make a copy of this application in <br /> preparation for this event. A copy of this checklist must be in the booth at all hours of <br /> preparation and operation. Return original to festival coordinator three weeks Drior to <br /> this event. <br /> 14. Completed by: <br /> Signature Title Date <br /> 1"�=;—.tee•-— --�----_ <br /> Permit <br /> 7 1 t 5-2-G:J <br /> Health i�erm It .: r� N811C'A 65h�':'e1i• <br /> � I <br /> i <br /> :artt:V Cxxe:- <br /> P^.._n0 st cnL <br /> t 'I Eoctn rius;be or. <br /> =rc_-ww-unk <br /> Iw J�se:+ix;er I 5'ea:'a17:'stet <br /> L� Garb_gc <br /> Ica Cooler <br />