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10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels) <br />^kTub to store wiping cloths in bleach solution. <br />12. <br />Water supply dispenser with warm water at a minimum of 1OO*F (r e. 5-20 gallon container with spigot) <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />M^Paoer towels and pump-style soap container. <br />13. <br />"Important** <br />March 232025 <br />Completed byz14. <br />Signature <br />Health Permit <br />Pasef Hard Toreii <br />OilxY) Soard <br />Ptop9^ S'.CvQ <br />ard WsteRrseV.'ate*Soap and Water <br />Pre f itrouisher <br />TEMP EVENT APPPage 8 of 11EHD 16-C2 <br />oamvie <br />ISdce chests <br />□ Refrigerated truck <br />□ Other (specify) <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I 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 />Sicmo <br />Dish <br />□ Refrigerator <br />Ice bath and tubs <br />5 Gaf Hand *asn <br />v,a?*a <br />S-20 GfiL <br />Krt wash Water <br />Garbage <br />Can <br />* ref buckci- <br />Ne&ch & wabm fet <br />Kor-ng *vng cSOthS <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra <br />Wafer <br />£>» tc>9 Sags 4 Food CoCvvt mat t* <br />6 otroft^OffrOLfaf <br />Co-ov^Netg- <br />Title <br />ice Cooler <br />taate <br />Proosne Tank ------—------ <br />Names of responsible persons to be present in booth during all hours of operation: <br />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