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10. <br />11. <br />OR <br />12. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />13. <br />14. <br />"Important** <br />f Datd' <br />15. Completed by: <br />Signature TIUe <br />Health Permit <br />P«t»r KsndTowwis <br />[ CtrtbhflBcart I <br />Piopitmt Slave <br />Pnwino Twm <br />a oap and watw KJnwWafcf UHetAendWMM <br />Rro ExHnfliatfw I <br />Ice Cooler <br />Page 8 d 11 TEMPfeVENT APP <br />1- <br />w; <br />! <br />GH016-02 <br />7/H/t5 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45’F (If food Is used the following day, maintain below 41*F temperature): <br />[Bice chests <br />□ Refrigerated truck <br />Efbther (specify) <br />Blvno wOoffwia <br />a«h <br />BiriiiicrbucAol- <br />bla«cri& wtur foe <br />•loring wiping ctfilii <br />6CW Hsndvnuri <br />WMlrrtwCcnknw <br />I <br />i <br />G^Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />Booth must bo on <br />Concrete. Asphalt, <br />Plywood, or a Torp. <br />.....- z <br />1- <br />'I <br />I am providing the following items within my booth for warewashing: <br />□ Three compartment sink. <br />EtThree deep tubs (basins 6-8 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 />520 Gal. <br />HandawhWats, <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />EHVater supply dispenser with warm water at a minimum of 100*F (l.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wasteweter. Paper towels and a pump-stvlo soap <br />container. <br />Garbage <br />Can <br />□ Refrigerator <br />QTtce bath and tubs <br />Name^r^sponslble during all hours of operation: <br /> <br />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 end operation. Return origins! to festival coordinator three weeks prior to <br />thia over* <br />FXtn» fro Bo0m Food ConMwt mitt IN <br />tfond OAtofttJ off ollhttyovndt [iq <br />Jl <br />r *