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i1D. 1--am providing the following cold temperature control For the cold holding of potentially, hazardous foods below <br /> 45OF(if food is used the following day, maintain below 41 OF temperature); <br /> Ice chests ❑ Refrigerator <br /> ❑ Refrigerated trunk ❑ ice bath and tubs <br /> i <br /> ❑Other(specify) <br /> 11, 1 am prov€ding the following Items within my booth for the sanitary cleaning of food preparaton utenslls: <br /> 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 /> ❑ detergent, bleach, and'wlping cloths(cleaning towels), ` <br /> I <br /> ❑ Tub to stare wiping cloths In bleach solution. <br /> 12. € am provlding 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 hob(bucket or basin)for the collection of rinselwas€ewater, <br /> I <br /> Paper towels and purnp-style_soaa container. <br /> 13, Names of responsible persons to be pre a t In booth durin 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. Returfl originaltojestival_coordinvitor three wooks prior to <br /> this event, <br /> 14, Completed by: r lG+ - - 4c,y�.� I ��r'i 5/9124 <br /> Signature 71he Dato <br /> 6-an cal. j <br /> Health Permit <br /> Ilondwash Walar <br /> Slarno wrChaifinp <br /> piste <br /> Paper}{anJ Taxolc <br /> 3oep diapenaer <br /> CVlltnpooard SaMltiorbuckal- <br /> bleach&Wale,for <br /> Prapuna Srova ateach sloring vriprny dolh c <br /> Booth musl be oil Concrete,Asphalt, I l <br /> i Plywood,ar a Tarp. <br /> Propann Tnnc ;' ,;i`'i r ;t •n:1 :4v�. .{ }: ';Y` '':-._` ':' r" �' <br /> - <br /> i i <br /> Soap end Walar lilnso Weler aloach and W+atar aRr�dyt I� <br /> FIFOExlhBvlcher R <br /> .r,. <br /> 5 Gal Hand wasly i <br /> Extra lac pays d Food Contalnera erwsThe wnsiaWaler Container <br /> elored 6 fnchOa off 0 the grounGY ' <br /> I � <br /> I <br /> 1 <br /> f <br /> Elan 18•02 Page 8 of 11 TEMP EVEN I'APP <br /> OQ101l18 I' <br />