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CAN .10AU1.1I14 y olvi -owlilental Fle--all"1) <br /> 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 /> M Ice chests X Refrigerator <br /> ❑Refrigerated truck X 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 utensil <br /> X 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(ono 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 /> ❑One separate tub(bucket or basin)for the collection of rinse/wastewater. <br /> P9 Paper towels and pump-st le sop container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> Mishael Moran <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 original to festival coordinator three weeks prior to <br /> this event. <br /> 14, Completed by: Mishael Moran Owner 6/21/2023 <br /> Signature Title Date <br /> r o Gal <br /> Health Permit Bard Nash wale, <br /> r)''•" Pd[+er!Idntl rowels <br /> 1 i•.n t.p..y.r <br /> ,',;[.r.q Eiu:va tl•abter butAol- <br /> 1 oleaIll d wale.,IV <br /> rtileazr_. _— sl::ru,g hgnny tloths <br /> WJra•a Stave -- <br /> Booth niust be on <br /> Concrete,Asphalt, <br /> 1 Plywood.or a Tarp. <br /> u•r.hanr c. . <br /> / $oar..arx+'J9aa 1w.-Mwr al.,,e,::pa:w:rmm <br /> / Garbage <br /> _ Can <br /> i Fx,Frtn«p.x51�:e <br /> Fri•. <br /> ::a:er <br /> Ice Cooler 5Ga Hans wa,1. <br /> r L.P.r fie B.rEJ.,ti rec4 Cantar±e•r.;r,,rvr be. '+:awnaJer E;anta ner <br /> is t ;: ` i„' t{r.r r :.,•ii'r t r .i .',�: <br /> f <br /> EHD 16.02 Page M of I I TEMP EVEN t APP <br /> 07r31:. <br />