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10 1 am providing the followng cold temperature control for the cold holding of potentially hazardous foods below <br /> 45°F(if food is used the following day, maintain below 41"F temperature) <br /> ❑ Ice chests ❑ Refrigerator /'j <br /> ❑ Refrigerated truck ❑ lce bath and tubs <br /> ❑Other(specify) <br /> i am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> ❑Three compartment sink. <br /> OR <br /> Three deep tubs (basins 6-8 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 rloths(cleaning towefs). <br /> Tub to store wiping cloths in bleach solution. <br /> 12 I am providing the followtng for adequate hand washing facilities, but separate from utensil wash within my <br /> booth <br /> Water supply dispenser with warm water at a minimum of 100°F (Le. 5-20 gallon container with spigot), <br /> , J One separate tub(bucket or basin) for the collection of rinsetwastewater <br /> Paper towels and pump-style§Qa!p container. <br /> 13. Names ot_{ ponsib}e s to be prese booth during all hours of operation- <br /> -Important— All 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 operation Return orlainal to NNLVal rdinator three m� weelks rlor to <br /> 14, Completed by: ,�wK —16—C, f-7 <br /> Signature Title Date <br /> Health PennitYT szo c4 <br /> 3temo wtChdtpq _ ManC wash Vwtiaar <br /> Oph <br /> soap J.rrw P�-lim Towels <br /> Curtnq BaarO _ <br /> SwAt[of brae <br /> bream b wars frr Rvprra Slora g�ti xomp wpy node <br /> 8000 must be an <br /> COrtcrete,Aspliar. <br /> Proaar�Ta�4 Piywow or a Tarp. <br /> rswp ono wade. P. wars ma.v,Wra waver <br /> Garbage <br /> - — —- Fm ertnwnrer Can <br /> ��rrr <br /> wale- <br /> i <br /> Ice Cooler <br /> Eats to Baps a Fuw ConVtr.e+r+rust t»� wUaNaw■rer Garaaaw <br /> shad 6 aafna oil Or pro gM_-.Y <br /> COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />