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•4 <br />10 <br />11. <br />OR <br />12.my <br />13. <br />‘•Important** <br />14. <br />Health Permit j <br />Paper Hara ToweJs <br />Soap dispenser <br />/ <br />Propane Stove Bleach i <br />■aPropane Tank <br />Bleach and Waler <br />Fire Exiirnu she/ <br />Ice Cooler <br />dSt-: 10'9191 aongd <br />0 <br />Exff^ ice Bags Food Contain&s must bo <br />sto/eo 6 inches oticl .'he ground! <br />Scemo w/Chaffmg <br />□»sh <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sandier frudtef- <br />Weacti 4 watm for <br />stonng wapirtg cloths <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />5-2d Gat. <br />Handwash Waler <br />A <br />) <br />OU <br />Title <br />OLjJ! <br />Rtnse Water <br />h <br />r <br />Soap and Wahsr <br />Booth .» on <br />Cp'.r. <br />j'hh,-.rp <br />Refrigerator <br />□ Ice bath and tubs <br />ULlUtZMCp <br />bate <br />~ . <br />— ------------1 <br />; Garbage ;ca" j <br />COMPLEl E BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <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 />chests <br />□ Refrigerated truck <br />O Other (specify) <br />\L <br />\ <br />1 f <br />I am providing the fallowing items within my booth for the sanitary cleaning of food preparation utensils <br />jZfrhree compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a oleach <br />solution (one tablespoon of bleach per gallon of water). <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />jzf Tub to store wiping cloths in bleach solution. <br />1 am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />JZf One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />j/j Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation <br /> <br /> <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event A----------* .... ... <br />preparation and operation. <br />this event. <br />Completed by: <br />Signature