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10. 1 am providing the fot;orving cold temperature control for the cold holding of potentially hazardous foods below <br /> 45'F (d food Is L*ad the following day, maintain below 41'F temperature); <br /> ® Ice Chests ❑ Refrigeratef <br /> ❑ Refrigerated truck ❑ Ica bath and tubs <br /> ❑Other (sPocifY) <br /> 11. 1 am providing the following items within my booth for the sanitary deaning of food preparation utensis: <br /> ❑ Three compartmoni sink. <br /> OR <br /> ® Three deep tubs (basins 6-B 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 wiping cloths(cleaning towels). <br /> ❑Tub to store mp4ng cloths In bleach salutlon. <br /> 12. 1 arse providing the following for adequate hand washing facifities, but separate frem utensil wash within my <br /> booth <br /> *VVal.m supply dxspanser with►varm water at a minimum of 1 DO`F(i e. 5-20 gallon container witty spigot}. <br /> ®one Geparate tub(bucket or basin) for the eok9 ctron of rinsetwastewater_ <br /> ® Paper towels and pum jtyig%oa container. <br /> 13, Names of resporisible persons to be present In booth during all hours of operation- <br /> Grace Zhao <br /> "Important" Alt food vendor booths are subjed to Inspectton. Please make a copy of this application In <br /> preparation for this event. A copy of this chockltst must be in the booth at all hours of <br /> preparabon And operation. Retum Qriginal to fast vnl coordinatoir throo weeks prior to <br /> t nt, <br /> 5114125 <br /> 14. Completed by-. <br /> Stgnature Title Date <br /> 529 GW <br /> 1 LWO w..r•►Iv <br /> Health Permit <br /> 7s.ir*.a�V+f1Y9 <br /> 0�' P��r Yrrs!iv.r1. <br /> 5�h OgOsyrsrr <br /> Grllrq W/m51 SanLeu lLLYII <br /> sure WT"rYshb <br /> rfcrrrr 6tw -. � _ <br /> Beath rru�Mph",ftt <br /> ee on <br /> _ Galcrete,My*'d,o Tarp. <br /> LT- <br /> 5:0 r.!NwR Fu r.wclx eMo-Pr wr.r GorGere <br /> r Can <br /> Fr.Emir,si.hw <br /> YFr. <br /> Ice Coolor 10.1 slit! fish <br /> Ent 1�r 1lagT ro.!Cu trr�rUW to ria:rrwrer CMlltt <br /> - atrrrr!ntYr�[fTdRy 7rrrrn:l' <br /> Elio 1G-0Z F'ige 4 of t t TEUP EV NT APR <br />