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10 <br />11 I am proving the following items within my booth for the sanitary cleaning of food preparation utensils' <br />OR <br />letergent.. bleach, and wiping cloths (cleaning towels}L <br />igjfist sfips to i tessure sanitatiori levels for bleach solution measuring lOOopm <br />JJ'ub to store wiping cloths in bleach solution measuring lOOppm <br />12. <br />rQPanertowels and r>iimn-g‘>-‘l= soar?container. <br />13 <br />1<Completed by: <br />I Health Perm II <br />? aper 14and T <br />CT7 <br />i E eash ynd '-rVatcrWaterJI <br />->’» xxvn-yiM ,-3.* <br />Ice Cooler 1 <br />TEL'? EVENT APF-P3J0» Qf11 <br />ts^toe chests <br />O Refrigerated truck <br />LJ Other (specify) <br />nS JL. j! <br />... Brandon AwoS* ^^Gnct'4 ScdHr <br />“'Important** All food vendor booths are subject to inspection <br />preparation for this event, A copy of ibis 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 svent. <br />I i Refrigerator <br />O foe bath and tubs <br />i am providing the following for adequate hand washing fac. Ries, but separate from utensil wash within my <br />booth: <br />I am prowdmg tile following cold temperature conticl fa: the cold holding of potentially hazardous foods below <br />45cr (if food is used the fcPov/iiig cay, maintain below 41'F temperature): <br />Oish <br />/ <br />/ <br />6 Gai f-tand wash <br />Waste -. ate f Ccr.U. <<n‘ <br />. i.-24S' <br />Jtearr ’» ter <br />_ OV/h<r< <br />Title <br />Ehf tt-S2 <br />Boct'i r-ws- be w <br />Orz'crslo Asprali <br />PI,-< J lurp <br />□ Three compartment sink. <br />deep tubs (basins C-3 “Ches "-i-rnum’ mm for so.-py wite- ar- hr r.sin i mid one to a .■.■■--sell <br />solution (ere tablespoon of bleach per golfen of water) <br />:•&‘present in booth during all hours of operation <br />/ £v<M^Aa j <br />• .—t <br />Garb.tgc; <br />Car: <br />j^Cwater supply dispenser with warm water at a minimum of 100T (i.e 5-20 gallon container with spigot) <br />separate tub (bucket or basin) for the collection of rinse/wastewater <br />s.ai <br />4and wish Wslr <br />/ <br />J D-uJLJIIz <br />- <br />I Sgap st J 'Ateu<r i <br />n\ <br />\ <br />Signature <br />G/Lf^-JSarf^s j. <br />Please make a copy of this application in <br />I Cull1 ng Q^ard <br />; Prapanc Siovg ! <br />I <br />- Hm-.m *. f'* I <br />r. .'rttASS c"vf I <br />Provens ’ fink