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10.1 am providing the following cc <br />14. Completed by: <br />Title <br />Health Permit <br />] <br />Paper Hand Tenvois <br />Cutting Board <br />Propane Stove <br />7'?'■'iLPropene Tank <br />TEMP EVENT APPEHD 16-4)2 <br />07/28/10 <br />Sterno w/Chahlng <br />Otsh <br />5 Gal Hand wa«h <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer buoket- <br />Meach & water for <br />storing wiping cloths <br />5-20 Gal. <br />Hand wash Water <br />z <br />Rinse Water <br />**Important**All food vendor booths are subject to inspection. Please make a copy of this application <br />in preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior <br />to this eventq <br />' Signature <br />1 '■ ■; <br />v <br />- - - ■ :mperature control for the cold holdir f potentially hazardous foods <br />tfelow 45 degrees Fahrenheit (if tood is used the following day, maintain i~iow 41 degrees Fahrenheit): <br />Ice chests M Refrigerator [ ] Refrigerated truck <br />[ ] Ice bath and tubs [ ] Other (specify):_ ________________________ __ <br />11.1 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 6-8 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 />|Xj Detergent, bleach, and wiping cloths (cleaning towels). <br />[X Tub to store wiping cloths in bleach solution. <br />12. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 100 degrees Fahrenheit (i.e. 5-20 gallon <br />container with spigot). <br />|X] One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />M Paper towels and pump-style soap container. <br />13 Names of responsible persons to be present in booth during all hours of operation: <br />______________________________________ <br />I Bleach <br />lea A Food ContHlnQrs muat TO <br />atored 0 Inctws off of ttHt ground! Lu <br />I Soap dispenser <br />- <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />\_______ <br />1 I B teachind Water <br />( Extra \ <br />I Water I <br />| I Soap and Water <br />Ice Cooler