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10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br /> 457 (if food is used the following day, maintain below 41°F temperature): <br /> ❑ Ice chests ❑ Refrigerator NIA Prepackaged Non Potentially <br /> ❑ Refrigerated truck ❑ Ice bath and tubs Hazardous Goods <br /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <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 /> NIA Prepackaged Non Potentially <br /> ❑ Detergent, bleach, and wiping cloths (cleaning towels), Hazardous Goods <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 (i.e. 5-20 gallon container with spigot). <br /> ❑ One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> N/A Prepackaged Non Potentially <br /> ❑ Paper towels and pump-style soap container- Hazardous Goods <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Ursula Kemp-Paden <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 prior to <br /> this event. <br /> 14. Completed by: J/,4� ", •ir/ 2 Z Z`i <br /> Sig atur Title bate <br /> 5-20 Gal. <br /> Health Permit Hand washWeter <br /> 5[emo w7Chaffing <br /> Dish <br /> Paper Hand Towels <br /> Soap dispenser <br /> cuttinq Board Sanitizer bucke[- <br /> taleach&water for <br /> Propane stove Bleach <br /> storing wiping Goths <br /> Booth must be on <br /> O Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> LF <br /> Propane Tank <br /> '- Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> Fire Extinguisher <br /> Extra <br /> Water <br /> Ice Cooler 5 Gal Hand wash <br /> Extra Ice aags&Food Containers must be Wastewater Container <br /> stored 6 inches"'off, <br /> of tha ground! <br /> EHD 18-02 Page B of 11 TEMP EVENT APP <br /> 08101/16 <br />