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\ 1 \ <br /> ' Note: Examples of potentially hazardous food include: meats, tamales,cooked beans,rice vegetables, <br /> potato salad, eggs and dairy products. <br /> 10 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods <br /> below 45 degrees Fahrenheit (if food is used the following day. maintain below 41 degrees Fahrenheit): <br /> lee chests [ ] Refrigerator [ ] Refrigerated truck <br /> ( J ice bath and tubs [ ]Other(specify) <br /> I I I am providing the following items within my booth for warewashin& <br /> V]Three compartment sink <br /> OR <br /> Three deep tubs(basins 6-8 inches minimum), one for soapy water,one for rinsing and one for a bleach <br /> solution(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 /> 12. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> [ ] Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br /> 13. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> Al Water supply dispenser with warm water at a minimum of 100 degrees Fahrenheit(i.e. 5-20 gallon <br /> cdntainer with spigot). A separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels <br /> and a pump-style soap container. <br /> 14. Names of responsible persons be present in booth during all hours of operation: <br /> Am-,LJs Md r-4- <br /> r, <br /> **Important** All food vendor booths are subject to inspection. Please make a copy of this application <br /> j in preparation for this event A copy of this checklist must be in the booth at all hours of <br /> preparation and operation. Return oriOmw to festival coordinator three weeks prior <br /> to this event. <br /> 15. Completed by: �!,t/rt.e r <br /> Si Title vate <br /> L <br /> Health Pormlt - -�wM N r• <br /> .- <br /> 1 fw. <br /> 1 r.aro MN <br /> —— <br /> Ice Cooler _... <br /> f..+.r YaM I•A.rJi; u(.rw..v r1� hila+N�•'� <br />