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10. 1 am providing the following cold temperature oorhtmi for the told holding of polentwIly hazardous foods below <br /> 45'F (if food is usad tho following day, maim in below 41`F temperature): <br /> N Ice Chests ❑ Refrigerator <br /> ❑ RefTigerated 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 /> ❑ Three comparlment sink- <br /> OR <br /> 2 Three deep tubs (basins " Inches mlydmum), one for soapy water, one for rinsing and one for a bleach <br /> solution (one tablespoon of bleach per galion of water). <br /> ®Detergent, bleach.and wiping dolts(cleaning towels). <br /> ❑Tub to store wiping cloths In bleach solution. <br /> 12. 1 am providing the following for adequate hand washing fadt~t,es, but separate from utensil wash within my <br /> booth: <br /> ®Water supply dlmpenser with warm walex at a minimum of 104'F(Le. 5-20 gallon container with spigot) <br /> ® One separate tub(bucket or basin)for the collection of rinseAwastewater. <br /> Paper towels and pump-sW soap container. <br /> 13. Names of responsible persons to be present in booth dunng all hours of operation.- <br /> David Dyson and Christy EkAinge r <br /> "Important" All food vendor booths are aubjed to inspectdon. Please make a copy of thls application in <br /> preparaton for this event. A copy of this checklist must be In the booth at air hours of <br /> preparation and operation Return oriclinal ig featty2l coordinator h we eks rlor t <br /> this event. <br /> 14. Completed by 5/14125 <br /> Signs ro Title Date <br /> Heaftih Pcrmlt wry r;.+•• <br /> Cisra r/iYuriaa <br /> a.n <br /> hWv Hn7 Tana <br /> 3nm C1ze•rar <br /> LILQ Aonrd � 6anitaar <br /> p�.� <br /> �tA'r StnN Qialh col _ at.t4.Rar9 i4rh1 <br /> /B.�oc�o ma be an <br /> l.Ar 11..r QfO.I11Sr+ay, <br /> ". . .. RyAucd.or a Tarp, <br /> •..crw Tarr —— -- <br /> Lna�r r-d N'J W qr•N 11iw RrM•M F1tf1+ Garbage_ <br /> Can <br /> 1r�rin - <br /> Ice Cooler i <br /> f.ra tr w,a a Fcrti!rur.►rr.rraut dr waar.rrr CL,r.I� <br /> +t-W anther vMcf Mw prargJr <br /> Page a Ce 11 TTJ64P IVGNr Apt, <br />