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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 /> U Ice chests ❑Refrigerator <br /> ❑Refrigerated truck ❑Ice bath acid tubs <br /> ❑Other(specify)'- G2 o-g,,tt QT S <br /> 11. 1 am providing the following items withln my t>oath for the sanitary cleaning of food prep lion utensils: <br /> OR ❑Three compartment sink. �y �a -}� 4 � <br /> [I Three deep tubs(basins 6-8 inches inimum),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 /> $�dne separate tub(bucket or basin)for the collection of rinsetwastewater, <br /> pr. aper towels and urn s le soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> '''Important"` Al food vendor boolhs 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!2 festival coordinator three weeks prior to <br /> this event. I ll <br /> 14. Completed by: <br /> Signature Title D <br /> 52Q Gel, <br /> Health Perm t Vm'd <br /> s4reo w'Chamng <br /> �lah <br /> Papa llsd Tmw4 <br /> Soap dispenser <br /> cumnQaow - swenre�>- <br /> Neaer 6 wale'hr <br /> 'imparts 5wve else' e1�¢iwpl'+9 cloars <br /> Booth must bean <br /> Concrete,Asphalt, <br /> Plywoc d,or a Tarp, <br /> aM Water 111M Welar eleach and Water <br /> Garbage <br /> Can <br /> Fm Ex4npdsher <br /> Este <br /> We1er <br /> ice Gooler 5SW Hr�d,aae <br /> Ewe ke eeQd 6 Fnod Gcnfevara rraxr De riprewater Contains <br /> rtla+eG 6#W-0&6T.v—dl <br /> EHD 1"2 Page 9 of 11 TEMP EVENT APP <br /> 0a10111e <br />