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Must be returned <br />10 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11 <br />X Three compartment sink <br />OR <br />D Detergent, bleach, and wiping cloths (cleaning towels}. <br />D Tub to store wiping cloths in bleach solution <br />12 <br />^A/ater supply dispenser with warm water at a minimum of 100 F (i.e 5-20 gallon container with spigot). <br />13 <br />7/9/25Completed by 14 7 DateSignature <br />Health Permit <br />Paper Hand Towot, <br />BloacnProennei Sto...f <br />Lt <br />Proe>ane Tank <br />I <br />Bleach and WaterRinscWator <br />F.re Eltnau.&hef <br />Ice Cooler <br />TEMP EVENT APPPage 6 of 11 <br />Owner <br />Title <br />EHD 16-02 <br />06101/16 <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-stvle soap container <br />D 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />Stcmo wIChaffing <br />Dtsh <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, ora Tarp <br />D Ice chests <br />0 Refrigerated truck <br />Other (specify)__ <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />' 45 F (1f food Is used the following day maintain below 41 °F temperature) <br />Names of responsible persons to be present in booth during all hours of operation: <br />Jayna Casey, Bret Casey <br />tma lci> Bags & Food <br />stored 6111 C/Oes <j« of,,, ground' <br />SGa Handw:ish <br />Wastewaler Container <br />Ofe frig era tor <br />0 Ice bath and tubs <br />N/a for us <br />20 Gal <br />Hanc wash Watltf <br />n.ii’.bio, bucket <br />bleach & water f()( stonng w.piOQ aOC'iS <br />L <br />Soap and Water <br />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 be in the booth at all hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />this event. <br />...Important'""