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10. 1 am providing the foGooMN cold tomperature control for the oold holding of polentralty hazardous Foods Wow <br /> 45'F (if food Is used the following day, ma:ntaln below 41'F temperature): <br /> ® ice chests ❑ ReNuerolor <br /> ❑ Refrigerated truck ❑ Ice bath and tubs <br /> ❑ Other(specify) <br /> 11 1 am providing the following Items within my booth for the sanitary cloaning or food preparation utcnsgs.- <br /> ❑Three compartment sink. <br /> OR <br /> EZ Three deep tubs (basins " Inches minimum), one for soapy water, one for rinsing and one for a bleach <br /> solution(one tablospoon of bleach per galk)n of water). <br /> ®Detergent, bleach, and wiping cloths (cleaning towels), <br /> ❑Tub to stare wlprng cloths In bleach solution. <br /> 12, 1 am providing the following for adequate hand washing facilities, but Separate from uto=l wash withln my <br /> booth: <br /> ®Water supply dispenser with warm wa!ar at a minimum of IDYF (I e. 5.20 gallon contalner Wth spigot) <br /> Ono soparatc tub (bucket or basin)for the collectlon of rinsnAvastewater. <br /> Paper totneLs and puyetp st)�e_so-U container. <br /> 13, Names of responsible persors to be present in booth during all hours of opera!on'. <br /> Joe or Ju5e Kolly <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 tea in the booth at all hours of <br /> preparation and operation. getum on anal to foslilyal rgorldinator throw wcokV pdor to <br /> thly event. <br /> 14. Complated by. _ 3/30/2026 <br /> Signature j Title Date <br /> Health PCrTTtil • ,,J• �•••• <br /> Era^u rCr n <br /> G.n <br /> r Prw Hu,7 T'�� <br /> �sa C1►..'W �, / <br /> [u2Yq 8�.ry SW tip r h+.1�1- <br /> bWCAa NO"" <br /> Hrnry n1:r`C dam• <br /> Wp�ex E4w <br /> Box-i rrvxt tc an <br /> 0 ('.C/ICrCT;n,Ill rY1A�. <br /> f PYACod,or a Twp, <br /> r.��•.ram, - <br /> 4-t S=��:r.Yr Wu�riY lrr!ey r.^rir� <br /> \\ G Can <br /> r r.r.:r•5. i. EN" 1 <br /> Ylrp <br /> Ice Cooler I 1 - 5 OJ FIYJ waft <br /> •I Fa;t�\;�9:yi i hxU C6't��'t nK lR Ylt�.'.r�vm Gn'iaF'r <br /> hied r n_Mr Nf d n.Y wn.+ <br /> EHp NT AX <br /> D4.7� r..� �r s t l C►fr[VE -V <br />