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10, <br />11, <br />OR <br />12. I am providing the following itams witnin my booth for the sanitary cloanifig of food preparation utensils: <br />CJ Datergent, bleach, wiping cloths (cleaning towels}, and a tub io store wiping cloths in bleach solution. <br />13, I am providing the following for adequate band washing facilities, but separate from utensil wash within my booth: <br />14.Names of <br />'^Important'’* <br />Complslad by: 15. <br />I. <br />Prc-Mfio Tiuii <br />Page ft Of It TEMP EVENT APP <br />I <br /> <br />Hoallh Permltpl <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45“F (If food 18 used the following day, maintain below 41’F temperature): <br />Booth must ba on <br />Carwsle, Asphalt, <br />Plywood, oreTsrp, <br />EHO 16-02 r/wis <br />5 OX Har>i <br />Westatrafef Coobmo* <br />520 Gai. <br />HflHJ’Wrtr.h WJtfir <br />i. <br />r <br />____ .. <br />| Cjiia .'tn Prr/pt Food Ccnta^m irt^ <br />I oioffMt o tKties ofTftl tirt <br />I am providing the following items within my booth far warewashing: <br />E^Three compartment sink, <br />iS'Three deep tubs (basins 6-8 inches'minimum}, one for soapy water, one tor rinsing and one tor a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />Titte Onto *' <br />Sflftiuwrhjtywb <br />blM5ii a water for <br />sldiing wftlna tfoUta <br />Papa* HaM Towa!» | <br />> I <br />QWatar supply dispenser with warm water at a minimum of WK (l.e. 5-20 gallon container with spigot), A <br />separate tub (bucket or basin) for lite collection of rinsB/waetewatar. Paper towels and a pump-stvlo soap <br />container. <br />Garbage <br />Can <br />st«rr« w'ChMfi nil <br />E?h <br />Ejtoe chests O Refrigerator <br />□ Refrigerated truck , / O Ice bath and tubs <br />Hothar(specify) <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 (his checkfet must be In the booth at all hours of <br />preparation and operation. Rettim original to festlva; coordinator three Wilts prior to <br />this eyuat,// <br /> <br />/ y signature <br />rasppnsible to b^present in booth during all hours of operation: <br />-.....—n-rjIce Cooler i j <br />Cirlthft Bantd <br />ftopnni Siorc <br />SiteAfft 1M V/W4V <br />Fira £|f{in.qiflsiior <br />Etf/a <br />WiKf