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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 /> Ice chests ❑ Refrigerator <br /> ❑Refngerated truck ❑ 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 utensils. <br /> ❑Three compartment sink <br /> OR <br /> ❑ Three deep tubs (basins " 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 Goths 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 /> ❑x Water supply dispenser with warm water at a minimum of 100'F(i.e. 5-20 gallon container with spigot). <br /> Q One separate tub(bucket or basin) for the cdledion of rinse/wastewater. <br /> ®Paper towels and pump-style soa container. <br /> 13. Names ofYesponsibte persons to be present in booth during all hours of operation. <br /> AjT I[nrlh <br /> vi d ]Fdwwol4 <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. Retum original to festival coordinator three weeks Drior to <br /> this event. /} <br /> 14. Cornpieted by; t _ lJ w� I;54 UY 2- /7 2(v <br /> Signaturlir Title Date <br /> Health Permit <br /> sw+o-ron�+�c <br /> Paw wn6 rowels <br /> Sa+o a�a <br /> C„mro Boa.d S".=&Ludlea <br /> nwz&a wWW la <br /> Copan.�. <br /> Booth must be on <br /> Corrsete,Asphalt. <br /> Plywood,or a Tarp <br /> so.p and Wm V41M R$NW Garbage <br /> Can <br /> F w F riqr�a <br /> be? <br /> VYaW <br /> Ice Cooler 5C-MiH"-4-A <br /> E�r.lA n e a rood cadwwv mud as Vpeag"sw cooww <br /> atrsf 6 rKtw d1 d no qro e _ <br /> EHP 5847 Pape 8 Oil r TEW EVENT APP <br /> 0"1 1 <br /> 76 <br />