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10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 45nF(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/A Prepackaged Food <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> ❑ Three compartment sink. N/A Prepackaged Food — No Utensils <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 /> ❑ Detergent, bleach, and wiping cloths(cleaning towels). <br /> ❑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 supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ❑X Paper towels and,pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> George Dale <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 /> Digitally,ignwi by George Dale <br /> DN_c=Gre Dale, <br /> 14. Completed by: George Owner <br /> 3/22/2017 <br /> L�iFf'�G t'pi�i YY 1 7 7 7 07'OC' <br /> Signature Title Date <br /> 5-20 Gal. <br /> Health Permit Hand wash Water <br /> Sterno w/Chaffmq <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> Cutting board Sanitizes bucket- <br /> bleach&water for <br /> Propane Stove Bleach storing wiping doths <br /> Booth must be on <br /> 0 Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water <br /> Garbage <br /> Can <br /> Fire E tioquisher <br /> Extra <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Bags&Food Containers must be Wastewater Container <br /> stored 6 inches off of the ground! <br />