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10, 1 am providing the fallowing cold lemperatura control for tho cold hording of potentially hazardous foods bakriv <br /> 45'F (if food is used tho following day, maintain below 41'f=Icmperaturo): <br /> 2 ice che515 ❑ Refrigerator <br /> Cl Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11. I am providing the foaorving coils wthin my booth for the sanitary cleaning of food preparation u.ensils: <br /> ❑Three comparin ont 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 cf breach pat ganan of vratat). <br /> ® Detergent, bleach,and wiping cloths(cleaning towers) <br /> ❑Tub to store wiping moths In bleach solution <br /> 12, 1 am providing the following fix adequate hand washing facilities, but separate from utensil wash within my <br /> booth: <br /> ®Water supply dispenser with warm vrater at a minlmum of 100'F(I.e. 5-20 gaflon container%viih spigot). <br /> ® One separate tub(bucket or basin)for the collec"of nnselwastewater. <br /> Paper towers and U!amp-stye soap container. <br /> 13 Name;of responsible persons to he present in booth during all hours of operation: <br /> Kylo Outntal,UarWlo Quiltni <br /> "Important" All food vendor booths are subject to inspection. Please make a copy of the application in <br /> pruparatlon for this event A copy of this checklist must be In the booth at all hours of <br /> preparation and operation ELSjurri on final to festirvat coordinator throe weeks plior to <br /> this event <br /> 14. Completed by. _ <br /> 5/14/25 <br /> 5fgnaturo Title Data <br /> S M u <br /> Health Pemtiit """Q�"ram' <br /> r•Km]-L��tirY <br /> // Papdr Huai T&__ <br /> S1,61.0 r tmjf fft <br /> 1lnr.l,A rN-r,. <br /> ©ooLh rn L&t be on <br /> Concre4e,Asphan, <br /> *' Pty%oW.or a Tarp <br /> 5u.y rd V%.fir Rr.r ly car li.wrh a+f11►RW <br /> Can <br /> Eon i - <br /> Waf� <br /> ff <br /> C � 3rwNFitntw�M <br /> irl'e lZ Eiv�i F.a;�Ct.l'illi.)ir�el 8• 'A b.ple.r7rr�111f <br /> tk��!6 niira uTd ati.,��tl' <br /> EHO16.02 PWO6oftt TFUP AJV <br />