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Environmental Health Department <br />10 <br />11 <br />OR <br />12 <br />'.'.ate' supp . d Spenser .vitn /.arm .vater ar a minimum of 100 F (i.e. 5-20 gallon containei th spigo’1 <br />_One separate :_b bucket or basin i for (he collection of nnsc/v.aste'.valer <br />, Paper tp.ve s ano Cum>st'.ie soap container <br />13 <br />'■Important'" <br />12 <br />i Health Pe-mit <br />"1 Hr-j :4 <br />I ■; e> .> • : <br />?■ • <br />10 <br />f:l« I '.r> ,>n<3 >V«iMFin*. <br />F*» Er •orV>r' <br />A copy of this checklist must he in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />Garbage <br />Can <br />Booth must t’e on <br />Concrete. Asphalt <br />Plywood ot a Tarp <br />I am provd ng the following cold temperature control for the cold holding of potentially hazardn i foods below <br />45 r uf food is used the following day maintain below 41 F temperature) <br />LJ Ice chests H Refrigerator <br />□ Refrigerated truck ice bath and tubs <br />□ Other (speetty).____________________________ -_____________________________________________ <br />f. I'w Hww <br />Wu*'«A.t1w Colltool <br />?>»<■ hi».-1 >-.*»■ <br />bU'.i:r A water *01 <br />I am p'ovic nc the follow ng 4or adequate hand washing facilities but separate from utensil wash within C'/ <br />booth <br />t rtr.'i <br />.V j‘> f <br />' orq n 1 <br />TEMP EVENT AT-P <br />MO CH <br />.. . • ■■■ <br />], <br />■Id <br />OS <br />DateTitle <br />- rr ■■ ■ ■ ; <br />Er^a ict B»S5 t O-ita.-’ers muW t» <br />I ^oltr^ grt^V <br />ZL <br />Scat *na <br />I . : • ■ <br />A; fooo vendor booths a^e subject to inspection Please make a copy of this application in <br />preparation for this event <br />preparation anc operation <br />this event. <br />Compteted by <br />Ice Cooler <br />\ <br />Signature <br />I .!____11 <br />lam provid ng the following items v. thin my nonth for the sanitary cleaning of food preparati m utensil <br />_ Three compahment sink <br />Three deep tups (basins 6-8 inches minimum), one for soapy water one for rinsing ana one for a blea <br />soiufon (one tablespoon of bleach per gallon of water). <br />Detergent bleach ana wiping cloths (cleaning towels). <br />Tub tc store wiping cloths m bleach solution <br />\ames o* respons ble persons to be present in booth during a l hours of operation <br />t /s ( 5 k{ 952051 T 20948 4 F 209 464-01’ ■ • <br />EHD 16-02 P;,ge 8 f>' ” <br />(AIS i&