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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 <br /> ® Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> OR <br /> ❑ Three compartment sink. NIA Prepackaged Goods <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 /> El [Detergent, bleach, and wiping cloths (cleaning towels), <br /> I� �-+ <br /> ❑ Tub to store wiping cloths in bleach solution, NIA Prepackaged Goods <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 /> ❑ Paper towels and pump-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Kyle Quintal, Danielle Quintal <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 /> '2� <br /> 14. Completed by: �r� ��� �n ,`'� <br /> Signature title Date <br /> 5-20 Gal. <br /> Hand wash Walor <br /> Health Permit <br /> Stemo w/Chafiing <br /> D]sh <br /> Paper Hand Towe#s <br /> Soap dispenser <br /> Cutlina Board Sanihzer bucket- <br /> bleach&water for <br /> Bleach <br /> slonng wiping dolhs <br /> Propane Stove <br /> Booth must be on <br /> Concrete,Asphalt, <br /> J Plywood,or a Tarp. <br /> Propane Tank <br /> Soap and Water Rinse Water Bleach and Water Garbage <br /> Can <br /> F#re Extinguisher <br /> Extra <br /> Water <br /> Ice Cooler ' 5 Gal Hand wash <br /> Extra Ice Bags B Food Containers must be Wastewater Conlainer <br /> stored 6 inches off of the ground! <br /> EHb 16-02 Page 8 of 11 TEMP EVENT APP <br /> 08101116 <br />