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3/22/2017 511741331.jpg <br /> 10 1 am providing the following cold temperature oontrol for the cold holding of potentially hazardous foods below <br /> 45Flit food is used the following day,maintain below 41'F temperature): <br /> {Flee chests ❑Refrigerator <br /> 0 Retngera£ed truck ❑Ice bath and tubs <br /> Q Other(specify}--_—-_.___- __-- <br /> 1? f am providing the following items within my booth for the sanitary cleaning of food preparation utensils <br /> 0 Three compartment sink <br /> OR <br /> 27hree deep tubs(basins 6-8 inches minimum). one for Soapy water, one for rinsing and one for a bleach <br /> Solution lone tablespoon of bleach per gallon of water) <br /> detergent. bieach,and wiping cloths(cleaning towels). <br /> 0-7-,,b to Store wiping Cloths in bleach solution. <br /> 12 t am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> 0 Water supply dispenser with warm water at a minimum of 100T 0 e. 5-20 gallon container with spigot). <br /> 0-0rre separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> 19-vaper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation. <br /> C fi' -i MC%ti's>r <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 mu <br /> Preparation and operation. st be in the booth at all hours of <br /> Return or" trial to <br /> thievent, festival coordinator three weeks riot to <br /> s` ..-� <br /> 14. Completed byI / <br /> Signature C h� iNrt'w iL !. 0// <br /> Title Date <br /> Nea;th Permit 5 2.Gat <br /> Sterno shhat[.vu3 Hand wash Water <br /> DishCu+.tin-Hoard $Oap dispenser Paper Hand?oHels <br /> trrcpane Stovr. Sanrhter Bleach <br /> t- <br /> Blearh bleach&water fpr <br /> storing wiping Goths <br /> Booth must be on <br /> �r°P�n"7a`* Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Soap and water Rinse Water <br /> Bleeth aria water <br /> fire Exhngwshw Garbage <br /> Exna <br /> Can <br /> ICe Cooler <br /> ^•.—•M� -.tea:' F_xlre tae shB s S Food red 6 r , must be <br /> e9 Cont �� Gal Nand wash <br /> rrrhps o,Yof U+e 9roundWastewater CoMairty <br /> EH[)16-02 <br /> OMI/16 <br /> page 8 of 11 <br /> TEAtp -VI-Ni <br />