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( <br />15. Completed by: <br />SigJ Date <br />O»bi»;<T <br />Ice Cooler <br />( <br />i.'-lb <br />1 <br />JJcMli t“ on <br />CcncnHo AscKmi <br />Ptywtxxj ixaT-ri,. <br />1 >- • • ■ > ■ -.. <br />tUM3t <br />lOM.’tJ Vt-»| •-•Cfj <br />**lm portant** <br />jaafiutsasLsa xau- <br />' Health Fermi! f <br />Title <br />Ag^naa^ttow MWJUitea^ <br />4 .T < .n itajj 1 J m, < n <br />!». XI? < t-e.'A J ..•I .•‘.•T's <br />CX *.,Q • j <br />All food vendor booths are subject to inspection. Please make a copy of this application <br />in preparation for this event A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior <br />to this event <br />XX'ZS “ “"te M <br />10. lam providing the following cold temperature control for the cold holding of potentially hazardous foods <br />V ow o egrees Fahrenheit (if food is used the following day. maintain below 41 degrees Fahrenheit)- <br />l^ ce chests [] Refrigerator [] Refrigerated truck <br />[ ] Ice bath and tubs ( J other (specify): 11.1 am providing the following items within my booth for warewashing: “-------- <br />1/J Three compartment sink <br />OR <br />[tfThree deep tubs (basins 6-8 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 />f ] Detergent, bleach, and wiping cloths (cleaning towels). <br />[>$ Tub to store wiping cloths in bleach solution. <br />12.1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />] Detergent, bleach, wipmg cloths (cleaning towels), and a tub to store wiping cloths in bleach solution <br />boothPr°V S ™g fOr adeqUate hand WaShing facilities’ bUt Separate from utensil wash <br />M Water supply dispenser with warm water at a minimum of 100 degrees Fahrenheit (i.e 5-?0 gallon <br />container with spigot). A separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels <br />and a pump-style soap container. <br />14. Names of responsible persons to be present in booth during all hours of operation: <br />—_______