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10. 1 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) N/� <br /> 11. 1 am providing the following items within my booth for warewashing: <br /> OR ElThree compartment sink. IV k — IV v W '-(' kscq) <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. 11 am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br /> �'Vater 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 persons to be present in booth during all hours of operation: <br /> --(-' (N A- At-- <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. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 15. Completed by: �2� <br /> (� - 7 <br /> Signature Title ate <br /> s-20 Gal <br /> Health Permit Hand wash Water <br /> Stemo wlChaifing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Curling Board Sanitizer bucket- <br /> bleach&water for <br /> Propane Stove Bleach storing wiping doths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> b u r Plywood,or a Tarp. <br /> Propane TanY, <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire EMinguisher <br /> EMra <br /> water <br /> Ice Cooler _ .. _ 6Gal Hand wash <br /> Extra Ice Bags B Food Containers must be Wastewater Container <br /> stored 6 inches off of the ground! _. <br /> ti <br />