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10 <br />11. <br />OR <br />12. <br />13 <br />14.Completed by: <br />Title <br />Health Permit <br />Cutting Bsard <br />PrcW'-'xj Sieve Ee-ich <br />3 0 <br />'rccane ’’a.-ik <br />5 sa^ ana 'A'ater <br />“ir? Sx'jT^u s-.er <br />Ice Cooler ' <br />P82« 9 of 11 7£f^ EVES’ ; ^P <br />| Sos: xspensar <br />r <br />Extra <br />vVawr <br />SaniUor bucket- <br />3’eatf'. -i .-s'sffbr <br />stxfiog wsi' ; jotr-s <br />□ Refrigerator <br />^ice bath and tubs <br />5 Ga! Han 5 ■.vasn <br />AVate. Co: :^-._r <br />Bocti must be on <br />Concrete, Asphalt <br />Plywood or a I arp <br />EHD 16-C2 <br />’ 1W14 <br />Gifra its i FtKa C&nwvrt r-.ust fi# <br />sfo.'t'J S foc-es o/rc." res gry.ir j' <br />5-20 Gal <br />Hana Atsh \'*aia* <br />Stem? * fCr.a“nj <br />Disn <br />Slice chests <br />J Refrigerated truck <br />[j Other (specify). <br />i =ape>- Want<Tu*9U <br />Rinse Water <br />’"important** <br />3 <br />‘ a^X'°y?inlthe fojow,n9 cold temperature contrci for the cold holding of potentially hazardous foods below <br />-.b F (If food IS used the fallowing day, maintain below 41 "F temperature): <br />2_AJ <br />Date <br />r <br />| Soap and Water <br />[^Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot) <br />Q;0ne separate tub (bucket or basin, for the coiieotior of' nse/Wast-water <br />Paper towels and pumo-styie soap conta ner. <br />Names of responsible persons to be present in booth during all hours of operation- <br />—XcA^/tk—___________ _______________________ <br />Garbage <br />Can <br />Ail 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 />oreparaton and operation Return original to festival coordinator three weeks prior to <br />this evejlt. <br />■ (V a v <br />Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />^Three compartment sink <br />Tl ee oeep tubs (basins inches minimumi one for soapy water. ons f0 rinsm-j and one fo a bfoach <br />solution (one tablespoon of bleach per gallon of water) <br />^Detergent, bleach and wiping cloths (cleaning towels. <br />Cyi-est st ips to measure sanitation levels for bleach solution measuring 100ppm. <br />^Tub to store wiping cloths in bleach solution measuring lOOppm. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth' '