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10 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods boI <br /> 45'F(if food Is used the following day,maintain below 41"F temperature) <br /> I <br /> ❑Ice chests 'Refrigerator <br /> ❑Refrigerated truck <br /> ❑Ice bath and tubs <br /> ❑Other(specify) <br /> 11 t am providing the following items within my booth for the sanitary cleaning of food proparation utensils <br /> ❑Three compartment sink. j <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 /> ❑ <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(re.5.20 gallon container with spigot) <br /> l <br /> r <br /> ❑One separate tub(bucket or basin)for the collection of rinselwastewater <br /> ❑Paper towels and pump-;lute soao container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <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 Drier to <br /> this event <br /> 14, Completed by: <br /> Signature Title Date <br /> ® Health Permit H>rQ M11 Yi1Yf <br /> a.n <br /> D,pr VLna T,�o'f i <br /> So,D e,3DenfN <br /> Cwoo Bane S+r.+rer e,c�r. <br /> Propon•Llor• D'e>:n ,tarry w,Md:>ws <br /> 110011,must 6e on <br /> c.....Asphalt, <br /> 13yw0od,or a Tam <br /> t <br /> Pra,ro T,M j <br /> se,p,newn,r P,+.w,ror D<.n•awu.r Garbage <br /> 1 Can <br /> Fn ErocaueMr <br /> E,Va <br /> wc,r <br /> i <br /> i <br /> )C@ C.00I@r <br /> _.. --' t e x•a.y,a ro,d c w n. <br /> _ -- n ire. w„t..,t«ew.•r i <br /> anrN e,crr,oR N ew Drum ! <br /> I <br /> EMD 10 02 pea.0 of f l TEPP EVENT APP , <br /> Oe,D1110 — � ' <br />