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,Im 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 /> [M Ice chests [ ]Refrigerator <br /> [ ] Refrigerated truck <br /> [,-<Ice bath and tubs j-fOther(specify): <br /> 11. I am providing the following items within my booth for warewashing: <br /> [ ] Three compartment sink <br /> OR <br /> [-fThree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> solu ion (one tablespoon of bleach per gallon of water). <br /> [ Detergent, bleach, and wiping cloths (cleaning towels). <br /> [v?fub to store wiping cloths in bleach solution. <br /> 12. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> [YJ Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br /> 13. I 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 100 degrees Fahrenheit (i.e. 5-20 gallon <br /> container 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. Na7; 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 <br /> in 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 Parade Manager three weeks Prior to <br /> this e <br /> 15. Completed by: =� �x'�e��f <br /> Signature Title Date <br /> Health Permit S20 Gat• <br /> samo wdCrhalrp Hand weah Water <br /> twh <br /> Payer Mend Tawb <br /> SosP aspanser <br /> CuNrg Boat <br /> Ssngtesr budtat- <br /> bleach 4"am for <br /> Prppahy saw , ator*q wlpbtp Cloths <br /> Booth must be on <br /> Concrete,Asphalt, <br /> Prppe Ten* PfYwood,or a Tarp. <br /> soap and Wear Rinse water Bah7ha ant WaW <br /> !. <br /> / Garbage <br /> Fire Erwhpuaher Can <br /> / n <br /> Ice Cooler <br /> Es4e/w S Gah Hand wash <br /> taped Food Corealners mual be Wastewater Comokw <br /> stared 6 inches ,Food <br /> Me yroundl <br /> EHD 16-02 <br /> 07/14/15 TEMP EVENT APP <br /> Page 6 of 6 <br />