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'1 <br /> 10. 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 /> ❑ Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> Other(specify)___ ----- --- _—_ ---- <br /> 11. 1 am providing the following items within my booth for warewashing: <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 /> 12. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils <br /> ❑ Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br /> 13. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br /> ❑ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br /> separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br /> container. <br /> 14. Names of responsible per�o s to�e present in booth during all hours of operation: <br /> —Important" 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 and operation. Retum original to festival coordinator three weeks prior to <br /> this event. <br /> 15. Completed by: <br /> Signature Title Date <br /> Health Permit Hand wash watef <br /> S:emo wiCnatnrui <br /> 04% <br /> Papa NarKf Tow.rfc <br /> C�tUrgl Board saniU.cr bucket <br /> bleach&water for <br /> PrcK,anc Sicvn weacl. %Wryj wiping Cloths <br /> Booth must be on <br /> Concrete,Asphalt. <br /> Plywood, or a Tarp. <br /> Propane tank <br /> Soap and Watar Rmw avatar Bleach and waler Garbage <br /> Can <br /> Fue Exbrvivsfu:r <br /> Cxlla — <br /> wat� <br /> Ficeooler SGal hand w-ash <br /> 61ra Ice&ape 8 Fond Conlanr must he wastewater C x to ner <br /> sfLvvd E nrhas cA rd the 9rou,0 <br /> EHO 16-02 Page 8 of 1 t l EMP EVENT APP <br /> 7114/15 <br />