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10 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 457(if food is used the following day,maintain below 41°F temperature) <br /> ❑ Ice chests ❑Refrigerator <br /> ❑Refrigerated tr:6AW <br /> ❑Ice bath and tubs <br /> q}ether(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 /> tuIrhree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> tion(one tablespoon of bleach per gallon of water) <br /> .Detergent bleach,and wiping cloths(cleaning towels) <br /> 5(Tub to store wiping cloths in bleach solution <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth <br /> Water suppty dispenser with warm water at a minimum of 100"F(i a 5-20 gallon container with spigot) <br /> 7fOne separate tub(bucket or basin)for the collection of rinse/vrastewater. <br /> aper towels and pump-style soap container <br /> 13. Names of responsible persons to be 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. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by 11kt4SfOJI <br /> Signature Title Date <br /> Health Permit <br /> SanO:A. X,1 <br /> booth must be on <br /> Concrete.Asphalt, <br /> C Plywood,or a Ta <br /> ,a,aro t.:ne• al,.+e',tiacr= C+iza:r arn]'fJ,uc� Garbage <br /> Can <br /> F...,a <br /> Ice Cooler �.N Halo wain <br />