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10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45aF(if food is used the following day, maintain below 41°>"temperature): <br /> Elce chests ❑ Refrigerator <br /> ❑Refrigerated truck ice bath and tubs <br /> ❑Other(specify) <br /> 11. 1 am providing the following items within my booth for warewashing: <br /> ❑Three compartment sink, <br /> OR <br /> Three deep tubs (basins 6-3 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 /> 12. 1 am providing the following items within my booth for the sanitary Cleaning of food preparation utensils: <br /> (JDotorgant, 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 booth: <br /> Water supply dispenser with warm water at a minimum of 1007 (Le. 5-20 gallon container with spigot). A <br /> separate tub (bucket or basin) for the collection~ of rinsefwastewater. Paper towels and a purno~styia soap <br /> container. <br /> 14. Names of responsible person$to be present in booth during all hours of operation: <br /> "Important'"' All flood v©ndor booths are subject to inspection. Please make a copy of this application In <br /> preparation for this event. A copy of this checklist must be in the booth at all hours of <br /> preparation and operation, Retum original to festival coordinator_threo weeks prior to <br /> this event <br /> 15. Completed by: CC(1r'r �i7�cd�ry � o�$ <br /> Sig ature Title Date <br /> 6-20 o� <br /> Health Permit "eidwowh`VPW <br /> ,�,nmo wra,mm�o <br /> ❑lu, <br /> F'bpar Hann 7ClYIOIt <br /> cu0��ll�nlar <br /> Miller INS" <br /> b*wo h6W-wTor <br /> Pm Pena Stow <br /> B10�1 awng woo%doth6 <br /> eooth rr i t t)e are <br /> C:onCrCte,,4.pha11, <br /> PlywaQd,or a Tarp. <br /> FivpmaTpnk - L"!: :� riA Or" 'kh 1s1�if+ s^1 I. ­Yi•, <br /> Soap arrd Waiar Rlna.Wafer nlwrh nndw.W Ga1't7A9C <br /> Can <br /> v,..fj1V r Ftn Fr¢1nWlahw <br /> •,1�^y;; j ,'�. G�Cra <br /> ,y,t �l'h/w Water <br /> Ice Cooler SGalHendweah <br /> fed;o Ica!'was 6 food CXxrinhtoro must La Wa�twvkar Gontnlrnr <br /> SiA1Gd 0lnClq;olforlrla pramd! <br /> EHD 16-02 P4;0 0 of 11 TEMP EVENTAPP <br /> 7N 4/16 <br /> I+ /A 1 Ll III hR/\ ,, in—II -All• III IYIM F[kr.A LLa <br />