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u <br />n..I am prodding the fcfitowing tterns within my booth to*’ the sanitary ctean:-ig of food prepsrai-on utensKs: <br />OR <br />12. <br />!_j Water supply dispenser with warm vraisr st a nMnirnum tx rC j ' F fi.e. 5-20 gtalfcn container with spigot! <br />13 <br />54,Completed by. / <br />Signature <br />| Sc-ls j <br />i Soa.’i <br />j Jv. <br />i <br />PrcjSTA “-"X <br />/it I <br />iT? <br /> !• <br />fA?S ?.&*'• <br />>. am provioing the fofowng cc-;d temperfttore cerirci fo- the ccid hpidiog c-f potenrtaily has^rdous fobos Setaw <br />45T (if feed is used the fpitowiitg day, maintain bsicw 4? °F tsmpe-aiurek <br />IJ <br />tw SVS'st .^■■ <br />Boot*', nus: b<j Ss <br />Poserets. Astfis!:. <br />Rjvraal sr a Tarp.J <br />I <br />[3 ice chests Q Refrigerator <br />Q Refrigerated trucK Q Ice bath and tube <br />(^Other ispesfy) <br />'Q lJ <br />£7 <br />si;^V <br />’'‘Importent’* <br />Title Date <br />i <br />^Tbrse compartment sink <br />SLThree deep, tubs .(basins 5-3 mchas mTirhum], or-e -C' sosoy water,.-one fc' rinsing and -one for a pieaeh <br />spiution sone tabfespocn cf biesch per galfcn sf water? <br />Sd Detergent, bleach. ard v/-p:ng olcths <ct«3sn:*sg rmvc:s; <br />^.Tes: sbss :o measure sanitation teveis for bleach sokraon reasunr’.g 's.OOp^m. <br />^“uij to stere wiping c’oths in btsech sciution measuring ICCoprr. <br />! am o-cvidir.g the folhwir.g for sdsguate hand washing faoh’.es b.;’ separate from vie ■ s v,es!' within my <br />booth’ <br />>‘Js invi’jriar. <br />sVeiiWittt OfXi3i :£< <br />5-20 QftJ. <br />•ra.-< ^rt- <br />»■ * 1 ' ; <br />ci# S’x5t'.^a.r-<r j <br />3 <br />-----—.—• <br />Gsrtssge I <br />Csn <br />scaurVMsw:. • <br />AiiSt'i ^'Pi. 1 <br />I .SterMi.'rr.-irv; <br />Oti? <br />iifre f?< 5H ji. F. Fid? '■-y.*?- r fa! i \ <br />I .,• <br />errs <br />VViwrf <br />n One separata lub (bucket or basfr.t for the ccteotfon of hnseAvastewatsr. <br />^"psper to wels and pump-style soap ’container. <br />Npffss of responsive persons to be present In booth duhng si! hours of operafron; <br /> —__________ <br /> <br />A3 food vender booths are subject to inspection. Please mal;e a copy of this apctESfion n <br />preparation for this event A copy or this checklist r-ust be in the booth as a's Fours -p; <br />preparation and operator.. Return original to festival coordinator three weeks prior to <br />this^eyent. <br />VL <br />r> ih/ mjo <br />! Ice Cooler I i r <br />£HC iMJ <br />: Health Permit p