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Q �� j ! Environmental Health Departn'te+tt <br /> *R r:%nj PMVtdWQ*W k0owing C04d("Il eratute cNxinv:A to ttie cold holding at potentially hsuaKlouB l0kx�t"'Tw <br /> WF 0f Rl,)d o used tha following d4y rjarntxtn bekn4 41'F tenlpemluto) <br /> (W"cfxasm ly Rofngaratot <br /> a R~are-d truck ❑ice bats,and tubs <br /> Q clew(spe-04} <br /> t ar:rprptrichrV the felloNvinq items within my booth for the sanitity cleaning of toted p(opatation utftnsil <br /> T+- t%coirnp<irtinent sink <br /> >2ree dleep tutu (t�asins 6-8 inches minimum). one for soaPy Water, one for rinsing aria pnd inr a CiOWII� <br /> s,hunon lone tableespoon of bleach per gallon of water) <br /> Letergent breach.and,&tping cloths(cleaning towels) <br /> ❑Tub to store wipm_q cloths in bleach solution. <br /> 12 f .ern providing the following for adequate hand washing facilities, but separate iron) utensil wtnsh within <br /> booth <br /> Water supply dispenser with warm water-at a iz)inin)urn of 1007(i e. 5-20 gallon container with spigot). <br /> {]One separate tub(bucket or basin)for the collection of nnselwastewater <br /> ❑Paper fowefs and pump-style Soap 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 applIc21,10n i <br /> preparation for this event A copy of this checklist must be in the booth at 0 hours <br /> preparation and operation Return orE final to festival coordinator three weeks rlor <br /> this event. <br /> 14. Completed by _ -- 1-� <br /> -" Sign Oure Title date <br /> spa a� <br /> Health Permit rrawwnnatweta <br /> s+ nrcnam q <br /> Dray <br /> r=opa µwmYoaM <br /> ;;aaa n::'r�or,anr <br /> L::•�.•,�ticlyd 594a*iPAf tHtin+l <br /> tWhh S'�to <br /> sl:r-N A-4*14 tun <br /> _ -- Booth Inuar <br /> �ancrete � <br /> - -- - Ptywdod,or <br /> _.. ,i :.,nPvr,ll6L3fa� Hn�4V:ata Iliaanh.nrxrwnlm �A(iidljkdl� r <br /> Can <br /> pl�,r�'l 41ir� <br /> l �r�sl s A,• ... r.:1e'�as+iirrtlrri <br /> aElv.a� Ak?�zJ l�,;guy�Nr',""s't+N %�SMSewetlf�w'w•`tiu"is��w:� —,..,.. <br /> a alit �'� !":36L1N '•-+.4.. - �_..« m,,.......�,:.. -.,,,..,,..-^.,+^,..�a. ��....J.111 <br /> v�M.i':a Yn �6+a:rt �w:e'fA;vim.r ��,4,am 1 Rti I r - --•--.._:.�,. <br />