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10, 1 am pcovidmg the following cold temperature control far the cold holding of potentially hazardous foods below <br /> 45'F (if food is used the following day,maintain below 41'F temperature): <br /> 9 Ice chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11_ 1 am providing tho following Items mthin my booth for tho sar•itary cioaning of food preparation utensils: <br /> ❑Three compartment s+nk. <br /> OR <br /> ® Three deep tubs (basins " ouches minimum), one for soapy wa.ef, one for rinsing and one for a bleach <br /> solution(one tabiaspoon of bleach per gallon of water). <br /> ® Doteroent,bleach, and wiping cloths (cloaning to,vels). <br /> ❑ Tub to store wiping cloths in bleach solubon- <br /> 12. 1 am providing the following for adequate hand washing facilities, bu' separata from utensil wash within my <br /> booth <br /> ®Water supply nispenser vrfflh warm water at a minimum of 100'F (i.©.5-20 gallon containmr with spigot) <br /> ($ One separate tub(thicket or basin) for the caitedion of rinseAvastowater_ <br /> ® Papet iowets and Purnp,zilyle soap container- <br /> 13 Names of responsible persons to be present in booth during all hours of operation: <br /> M,.qurad1Tarek <br /> "Important" All food verWor booths are subject to inspecbDr1. Pleaso make a copy of this application in <br /> preparadDn for this even' A copy of this checIdist must be in the booth at all hours of <br /> preparation rind operation Rotu_rt1 original to festival c22rdtnator three weeks prior to <br /> this event. 1V <br /> 14, C xnpietcd by �_ / 5/14/25 <br /> e_--31 g n a tltlt`e Title Dale <br /> d:9 rr <br /> Health Penult WW—..»r <br /> aw <br /> F'Xw µrd%-0i <br /> Caa rc h:+-1 <br /> 5,rlbar wu.c <br /> RLgxr,l JL•.• �,.r 11mrg"Tm2 u:ra <br /> a=h mLsi be on <br /> corwto.A.xphalL <br /> Ptywx�d,at a Twp. <br /> h.c=-.T r k <br /> e: C,r• �al'r,'•fr Rl-r N'rlr ft."arid-A'aler <br /> E <br /> Gan <br /> Fur rl-q.r.•.. <br /> wY <br /> _ 71 <br /> [� <br /> FfC <br /> "odor I V W w4a>. <br /> . <br /> f.11 r[Eii.,v a Fw.1 c—Ls. r m.H 6r µ'+a��M+Ccaftr <br /> •!�J!Rz1+r■wt�!.r p�.r.6' JJII <br /> EM 19-02 Page cr S f <br /> MAM n� T t'.Sj EVENT APP <br />