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R <br /> 10. I am providing the following cold temperature control for the cold 'voiding of potentially hazardous foods belc:•r <br /> 45T(if food is used the following day,maintain below 41'F temperature): <br /> Ica chests ❑Refrigerator <br /> ❑Refrigerated truck ❑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 compararrnent sink <br /> OR <br /> ❑ Three deep tubs (basins n-a inches minimum), one for soapy water, one for rinsing and on$ for a bleach <br /> solution(one tablespoon of bleach per gallon of water) <br /> L Detergent, bleach, and wiping cloths(cleaning tov:reis! <br /> j Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br /> [1 Tub to store wiping cloths in bleach solution measuring 100ppr.n. <br /> -2. 1 am providing the following for adequate hand washing facilities, but separate from utensa wash within my <br /> booth- <br /> ❑Water supply dispenser with warm water at a minimum of 100 (i.e. 5-20 gallon container with spigot). <br /> L]One separate tub(bucket or basin)for the coliectior of nnsellrrastewater. <br /> �'� ❑Paper towels and pump-style soao container. <br /> 13. Nanies of responsible persons to be present In booth during al!hours of operation: <br /> 54nD VI <br /> 20 <br /> "Imp <br /> o <br /> rtant" AH food vendor booths are subject to inspection. Please make a copy of this application .n <br /> preparation for this eve-it. P, copy cf '.his cheok'ist r ;ust be in the booth at all i r� <br /> preparation and operat a- urn oricLinal to festival coordinator three v✓eeks prior to <br /> this a; nt. <br /> 14. Complete <br /> �5 <br /> Sign r Title <br /> - <br /> LHealth Per if ` `' ( t— 42M'Aryl <br /> Stern WChal) <br /> Sa::ast>a^:er <br /> r.;ur.tucks:• <br /> Die.,&wet er for <br /> ProOax Stota o.r,:;, r u^akts N6ti-�qaM <br /> 1 I) <br /> Booth crust be on <br /> -- 0_.O_ <br /> Loncrete.Asphalt, <br /> "- Plywood Ora Tarp. <br /> 6a:,'Yt3:^.'31E• <br /> 1 Garbage <br /> is uafr3 ur Can <br /> s^.ate: <br /> Ice Cooler <br /> 5 Gal,. <br /> ar.9 was', <br /> i rtra::e 8egs 6 r, Ga tawr:e'S mus.'Ce St�'atsr,,;r:ai%cr <br /> Psae s of t I 7EW? <br />