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10. I am providing the following cold temperature control for the cord hording of potentially hazardous foods belcve <br /> 4YF(if food is used the following day,maintain below 41`F temperature): <br /> I�lce chests ❑Refngerator <br /> l❑Refrigerated truck 171 Ice bath and tubs <br /> ❑Other(specify) <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <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 /> [Detergent, bleach. and wiping cloths(cleaning towels; <br /> !.I Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br /> ❑Tub to store wiping cloths in bleach solution measuring 100ppm. <br /> 12. I am, providing the following <br /> booth, for adequate hand washing facilities, but separate from utens'1 wash within my <br /> PlVater supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot) <br /> tg'bne separate tub(bucket or basin)for the coilection of rinsialwastewater. <br /> per towels and hump-style soap container. <br /> 13 Names of responsible persons to be present in booth during all hours of operation: <br /> Da U-e-v� l6 a.g-e- <br /> *Important" All food vendor booths are subject to irspection. Please make a copy of this application .n <br /> preparation for this event. A copy of this check'.�st :s' be in t' e 5oz;th at all boars o` <br /> preparation and operation:. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed <br /> by--_VIC AVl.(— <br /> Signature Title Date <br /> LHealth Permit - \ am ntsr�•;air <br /> Sterna w.rCra".�� <br /> Paper Viani carets <br /> C. :'2 aoad \ SerJf2erWxket• <br /> Dteuh 3 wetar for <br /> P:oaAS 5;owe Breach soft W*a clogs <br /> Booth must be on <br /> _ I / Concrete,Asphalt. <br /> Li <br /> Plywood.or a Tarp. <br /> ?rceena Tank / . <br /> .wf: anj t`.'3t� 1 . <br /> Garbage <br /> 'se cxe'tgssner <br /> Can <br /> ?x;fi <br /> h'axr <br /> Ice Cooler — ca-aryaasn <br /> Fwtl Cr ra:a ,us'he f- 1:�; -nKet�:r.;ai•cr <br /> `--- -- s!:'e2Einc�eaoA'araefl. I <br /> cHC 82f.�.�, ?of 1 -MVP E\CviAG P <br />