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Sterna w/Chaffing <br />Dish <br />Soap dispenser <br />5-20 Gal <br />Hand wash Water <br />Paper Hand Towels <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping cloths <br />( <br />Health Permit <br />Garbage <br />Can <br />Bleach and Water <br />Fire Extingu sher <br />Cu ling Board <br />Propane Stove <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />I 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 />Olce chests LI Refrigerator <br />0 Refrigerated truck E Ice bath and tubs <br />0 Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />0 Three 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 />ErDetergent, bleach, and wiping cloths (cleaning towels). El Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />CI Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />21 Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Sikqa af,ya a 4 <br />OR <br />**Important** All food vendor booths are <br />preparation for this event. <br />preparation and operation. <br />this event. <br />Ptali tignature <br />subject to inspection. Please make a copy of this application in <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />14. Completed by: 0 tA) <br />Title <br /> <br />og /2491,41 <br />Date <br /> <br />Ice Cooler <br /> <br />5 Gal Hand wash <br />Wastewater Container <br /> <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground , <br />