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1Q_ I am providing the fo3DWng cold temperature control for the cold holding of potentially hazardous foods below <br /> 45'F(if food is used tha following day, rrwin"n below 41'F temperature): <br /> ® loo chests ❑ Refrigerator <br /> ❑Refrigerataa truck ❑ Ice bath and tubs <br /> ❑Other(specify) <br /> 11. I am providing the fallowing itnms within my booth for the sanitary cleaning of food preparation utensils; <br /> ❑ Three compastrnent sink. <br /> OR <br /> ® Three deep tubs (basins " 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 (deardrig towels). <br /> ❑Tub to store wiping cloths In bleach solution. <br /> 12 1 am providing the following for adequate hand washing fadlitles, but separato from utensel wash within my <br /> booth <br /> ®Water supply dispenser with warm water at a minimum of 1 DD'F(i e, 5-20 gallon container wrth spigot). <br /> One separata tub (bucket or basin)for the collection of rinseAvastewater. <br /> ® Paper towels and pump-slyio sw owtainer. <br /> 13. Names of responsiblo persons to be present In booth during all hours of operffbw <br /> Steven Lewin,Sabrina Lewis <br /> •'Importard " AN 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 operalion. lietum ri o festival coord[natcw threg weeks Ddor to <br /> thl e <br /> 14. Completed by: 5/14/25 <br /> Sig <br /> Title Data <br /> s-M ar <br /> Health Permit �ra.unw.W <br /> r�r..rvrll.q <br /> coo, <br /> Plr,!1 f VrU Ta"Q! <br /> C.riry 6:..vd <br /> SYI[le ltu.ar <br /> CY.-"i%rr kz <br /> Ed h rl"Q�►7+i <br /> Boon must be on <br /> Crn nrmo,Asphaa, <br /> Plywmd,cr a Tarp <br /> �{A"'Tyr► _._ - _�- - _ _ 'f <br /> S_.yr,dWrs forrlwr• P1n:hruWir G.itDapR <br /> Can <br /> ___ FF�Ea11ps�Fw <br /> N air <br /> I!t:t3 Cooler <br /> s ell"a,a rul, <br /> EsTd Am Ayl a Axd Ca-ura-v•..uc'Ir W�Mtlr LmlaY•a <br /> [UIW 1 lti."1 ee d Br pm.nT <br /> EHO 1"2 Ram �r 1I 1EUP EWNT APP <br /> Ca'aVIa <br />