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Environmental Health Department <br />r <br />OR <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with <br />spigot). One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: Breanna Woodyard / Julie Coldani <br />14. Completed by: <br />Health <br />Permit <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Stemo w/Chaffing Disn <br />Fire Extinguishe' <br />12. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />Three compartment sink. <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 />Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution. <br />Paper Hand Towels <br />Sanitizer bucket <br />bleach & water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete. <br />Asphalt, <br />Plywood, or a Tarp. <br />Signature Title Date <br />R.TH Hal <br />Ice Cooler^,, /ce4 p00(j <br />Containers must be 6 inches off ot <br />“Important** 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 />10. 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 />Ice chests Refrigerator <br />Refrigerated truck Ice bath and tubs <br />Other (specify) <br />Water <br />Bleach and t.Vaterga^g^