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10. 1 am pnmrld[ng the following cold temperature control for the cold holding of potentially hazardous foods bskr& <br /> 45aF (if food is used the following day, mwntain bolow4laF temperature): <br /> ® Ica chests ❑ Refrigerator <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I am providing the following Items within my booth for the sanitary cleaning of food prepamtion utenslls: <br /> ❑Throe compartment sink <br /> OR <br /> ® Three deep tubs (basins 6-8 Indies minimum), one for 6oapy water, one for rinsing ano one far a bleach <br /> solution(one tablespoon of bleach per gallon of water). <br /> ® Detergent, bleach,and wiping cloths(deaning to'wels). <br /> ❑ Tub to store wiping cloths in bleach solution. <br /> 12 1 am pnNidng the fo4awing for adequate hand washing facilities, but separate from utensd wash within my <br /> booth: <br /> ® Water supply dispensor with warm water ad a minimum of 100aF (i.e. 5-20 gallon container with spigot). <br /> ® One separate tub(bucket or basin)for the collocbon of rnse,`wastewater. <br /> ® Paper towels and aumrr3tylo soap containei. <br /> 13. Names of responsible persorts to be present in booth during all hc:us of operation., <br /> Lindsey Shrader,John Wgraln <br /> aalmportsnYa AA 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 operatlon. Return odainal to fastival coordinator three weep,odor to <br /> th <br /> 14. Compielod by. <br /> gnature Title Date <br /> Health Permit rrd.aah A'a*r <br /> Qs-a a�JrA rq <br /> G � <br /> rkw Nartl T[rJ■ <br /> 5vp a�■r■w <br /> C+inc GcrN <br /> inuan ou�r- <br /> W�-:5e� iha.T i w■ts ha <br /> i:..• ■►nip�n�Grtln <br /> Boom must be Dn <br /> :�.Orr[1Li6. t1WL <br /> h <br /> Myv#Dod,or a Tarn <br /> i�[nne Tarp <br /> �s <br /> . ��,ann W;fr ler+r v1'aHr h.■rh.�d 1►�■y de�Odpe <br /> I►�r 3rtuNae can <br /> E.1 a <br /> ff Mw <br /> Ice Cooler IL-rI a aw HM%j b"h <br /> L / &A a 0" a r rear <br /> pm..r0 our ba WIMP* t C Shan r <br /> fff a4vwf�aclw.drum�r�wre <br /> t_I-aD 1"2 <br /> Galat1TG Pigs 8 of 11 TERN EVENT APP <br />