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10. l am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45`F(if food is used the fol' ig day, maintain below 41 F temperature): <br /> X•ice chests ❑ Refrigerator <br /> Refrigerated truck ❑ Ice bath and tubs <br /> U Other(specify) <br /> 1. I am providing the following items within my booth for the sanitary clearing of food preparation utensils: <br /> ❑Three cor impartment sink. <br /> OR <br /> Three deep tubs (basins --c as minimum), one for soapy rv;ater, 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 /> Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br /> Tub to store wiping cloths in bleach solution measuring 100ppm. <br /> i am providing the following for adequate hand washing fac!;i:ies, b t separate from utensil wash within my <br /> booth: <br /> 1Z_Water supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin)for the collection of rinss,"wast=water. <br /> Paper towels and pump-stv`' snap container. <br /> Naves of responsible perso"is to be present in booth during all hours of operation: <br /> "Impor~ant" 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 fes`ival coordinator three weeks prior to <br /> this event. <br /> -Z <br /> 14. Completed by: - ;�� — --- <br /> Signature Title Date <br /> 5-2� --' <br /> Hand.was- <br /> Health Perini? - <br /> Sot:a spessar <br /> cutting,5.3a Saraze Cxxa:- <br /> We9'vi 6 water'cr <br /> stafln5 w N--=lot's <br /> Booth must be on <br /> J I j Concrete.Asphalt, <br /> Plywood,or a Tarp. <br /> =ro arw a's <br /> i a an t-• Rns=V;at=_r I �aa�ar:y:'later Garb a e <br /> t_ Cary <br /> E) <br /> lr:ater <br /> t <br /> !ce Cooler <br />