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i <br /> 10. 1 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 417 temperature): j <br /> ❑Ice chests Refrigerator <br /> ❑Refrigerated truck ❑Ice bath and tubs <br /> ❑Other(specify) <br /> ! <br /> r <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> JNThree compartment sink. <br /> OR <br /> ❑ Three deep tubs (basins M 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 /> ! <br /> ' Tub to store wiping cloths in bleach solution. <br /> 12. 1 am providing the following for adequate hand washing facilities, but separate from utensif wash within my <br /> booth: <br /> 'gWater 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 /> Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> ..�-�r1J1 \�(li\ 1�Ol.iyZ <br /> J 1 <br /> t <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 /> I <br /> preparation and operation. Return original to festival coordinator three weeks prior to <br /> this event. <br /> 14. Completed by:_—��^/ lrfOLA/rum- 3h25 tc <br /> Signature Title Date <br /> 5.20 Gal 1 <br /> Health Permit Hand wash Water <br /> Slemo wlChaffirg <br /> Dish <br /> PaperHand Towels <br /> Scrap Dispense' <br /> Cutting Board SardGxer bucket- <br /> bleach 8weterfor 1 <br /> Propane Stove Bleach staring wiping Baths <br /> Booth must be on <br /> Concrete,Asphalt, 1 <br /> Plywood,or a Tarp. I <br /> Propane Tenk <br /> soap and Water Pmse Water Bleach end Water Garbage <br /> Can <br /> Fire extingwsher <br /> Extra 7 <br /> Watef <br /> IceCoolerI 5Ga1Hand Wash <br /> Eras ke Sags d Food Containers most be Wastewater Container <br /> r' were d inches orrorlhe ground! <br /> I� <br /> EHO 16-02 Page a of 11 TEMP EVENT APP 1 <br /> 08/01116 11 <br /> I <br /> i <br />