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10. 1 am providing the following cow 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 the sanitary cleaning of food preparation utensils: <br /> A ❑ 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 /> k/k ❑ 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 /> nn ❑Water supply dispenser with warm water at a minimum of 100°F(i.e. 5-20 gallon container with spigot). <br /> fU rT <br /> ❑ One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> ❑ Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> tC- 1�:t T-F J 3t; e 'i` %6&La0 <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 /> t event. <br /> 14. Completed by: &Uoitt:,y <br /> ��/ 0 Signature Title Date <br /> 5-20 Gal. <br /> Health Permit FHand wash Water$ICrnU7-1--11 <br /> halrrx� <br /> Piper Hand Towels <br /> Soap dispenser <br /> Culling Board Sanitlzer burkt <br /> bleach&water for <br /> Pmpanc Sfovc Bleach storing wiping cloths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp_ <br /> Proparre Tank <br /> Soap and Walcr Rinx wal�r BFcach arW Waley Garbage <br /> Can <br /> Flro Exhngufsher <br /> Extra <br /> walar <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice Bags d Food containers must be wastewater C—laincr <br /> storrd 6 arches off a the ground? <br /> END 16-02 Page 8 of 11 TEMP EVENT APP <br /> 08/01116 <br />