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Health Permit <br />. Cu Mg Board <br />Propene Stove <br />Sterne wiChaffing <br />Dish <br />;44'0 ,1E6;9 <br />11111111111 <br />,074;VYr4zr; . • 'v15''1}t- <br />6-20 Cal, <br />Hand wash Water <br />Paper Hand Towels <br />Sanllizer bucket- <br />bleach & water for <br />storing wipIng cloths <br />;43 <br />Ice Cooler <br />ENO 10.02 <br />DC1101/10 <br />Beep and Water <br />Fire Extinguisher <br />heirs too Ow 4 Food Containers owl be <br />stored Inches olt ths vroundl <br />Bleach and Water <br />TEMP EVENT APP <br />Rinse Water <br />Page 8 of 11 <br />Bleach <br />Garbage <br />Can <br />Soap dispenser <br />8 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />'10. ' providing the following cold temperature control for the cold holding of potentiallyI hazardous foods below <br />45°F (If food Is used the following day, maintain below 41°F temperature): <br />XI Ice chests Refrigerator <br />0 Refrigerated truck 0 ice bath and tubs <br />0 Other (specify) <br />11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />. Three compartment sink. • <br />OR <br />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 />D Detergent, bleach, and wiping cloths (cleaning towels), <br />0 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 />(inisl Water supply dispenser with warm water at a minimum of 100°F (1.e, 5-20 gallon container with spigot), <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />IN Paper towels and pump-style soap container, <br />Names of responsible persons to be pre&ent in booth during all hours of operation: <br />bez:,,t1 ner e r ke-Le t`q 0 d—ty <br />"Important** All food vendor bodths 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 oripinal to festival coordinator three weeks prior to <br />this event. <br />bi Completed by: %.31e4e4.,-, dt' • <br />Si nature • <br />Or (Lel /Ofiell; <br />Title Date <br />5/9/24