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10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by; <br />Health Permit <br />Hand To»«l» <br />So«p ditpenwr I _____ <br />Cutting Bcwd <br />Propane Stove BJeaito <br />Soap and VJaM fttmw Water Bteoat and Water <br />Fk« Ertnaulaher <br />Psg« 8 ol 11 TEMP EVENT APPEHD IB-02 <br />08/01/JB <br />$J«rna w/ChafMa <br />DUh <br /> Refrigerator <br /> Ice bath and tubs <br />Garbage <br />Can <br />5 OsJ HjindMiah <br />WMlcr*»tar Cwlain«< <br /> Booth must be on <br />Conaeto, Asphalt, <br />Plywood, or a Tarp, <br />Sani£z*r txK*»V <br />«xma <br />Exlnt ic# Bejjs & Food Cootaition moil ba <br />BtOfud fl hchtii off ot the grountfl <br />| Propar^i TwiX <br />Ice Cooler B <br />5-20 Gal. <br />V- Hand wuh Water <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45 F (it food is used the following day, maintain below 41T temperature): <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) ^ <br />a er 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 /> Paper towels and pump-style soap container. <br /> <br />Tahte 8 Copy of lhis aP*aUo^n <br />preparation and ’!’11 h°- <” <br />providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> Three compartment sink. <br />Siullon (oS tab^spoono? bleacl^perganmo/waie?™ . W °ne * and °"a 8 <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths In bleach solution. <br />booth: 9 th0 followin9 for adequate hand washing facilities, but separate from utensil wash within my <br />a copy of this application inpreparation for this event <br />gevent t^e w°eeks'X to <br />Eton <br />Waltx