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10. 1 am providing the following 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 /> r <br /> F-] ice chests ❑ Refrigerator I <br /> Refrigerated truck ❑ Ice bath acid tubs <br /> ❑Other(specify) j <br /> 11. 1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: f <br /> Three compartment sink <br /> OR <br /> M 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 cloths(cleaning towels). <br /> ❑Tub to store wiping cloths in bleach solution. <br /> 12. 1 am providing the following 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(i.e. 5-20 gallon container with spigot). <br /> U One separate tub(bucket or basin)for the collection of rinselwastewater. <br /> Xpaper towels and pump-sfyle soap container. <br /> 13. Na a of r pons'ble erscns to be present in booth durin all hours of operation: <br /> �G� �.���. �Vc <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 checkJist must be In the booth at all hours of <br /> preparation and operation. Return ortainel toj9,$tEval coordinator three woeks prior to <br /> this eve t- <br /> 14. Completed by: 21 elt'� in <br /> gnat re Title date" <br /> Health Permit HwId wui+W.i.r <br /> s�wacw�r� - <br /> oen <br /> Prper VWVq Towel* <br /> Seep tisM++.ar - <br /> Guunp HaarC fi.nrl44g GXhe4- <br /> 61.sch 6 w.ar kv <br /> vio(wH 51ar. FlhacJi 1(OrYp w'WG chins <br /> Booth must t*on <br /> Concrete,Asphalt, <br /> Plywood,or a Tarp. <br /> Pcgvq Trdt -- <br /> SotD.rxl W.b Mow N'al.r 81esdh Wed Vftler Garbago <br /> Can <br /> Fre Eaenpuisl,er <br /> Ezra <br /> YJal.r <br /> Ice Cooler 5G.1 Hand <br /> r.wh <br /> s food twrtrw.nw.r b. w.�b...rr ConuY�.r <br /> -- -- --- ,:o,ncai„Ma�aorrollMp,ow.dr <br /> COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />