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I <br />10. <br />11.I am providing the following items within my booth for the sanitary cleaning ol food preparation utensils <br />□ Three compartment sink <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12 <br />13. <br />“Important** <br />Completed by 14. <br />Signature <br />Health Permit <br />;<>. ii> (fispen.'.Bi <br />BIp.ii,fPiop.iite Stove <br />Propane I .ink <br />Rinse Water Bleach anil Water <br />Fire Extinnuishei <br />TFMP EVENT APRPage 8 of 11 <br />5 Gal Hand wash <br />W.isle waler (..onlainei <br />0 <br />FHD 16-02 <br />08/01/16 <br />Qnhree 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 />Extfn Ice Biujs & Foot! Conlmners muni he <br />stored 6 Inches ott ot the ground! <br />Sterno w/Chulling <br />Dish <br />Exira <br />Wah‘i <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />□ Refrigerator <br />□ Ice bath and tubs <br />aannizer im< k>ji <br />bleach A waler loi <br />itorini) wiDinq < lollr. <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 />Q^lcc chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Ob ' <br />DateTitle <br />1 <br />Soap and Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth. <br />Q^Vator supply dispenser with warm water at a minimum of 100 F (i.e 5-20 gallon containei with spigot) <br />0Onc separate tub (bucket or basin) for the collection of rinse/wastewaler <br />Q^Papor towels and pump style soap container. <br />Names o.f responsible persons to be present in booth during all hours of operation: <br />VO Pt'S ID <br />Ice Cooler <br />All food vendor booths arc subject to inspection Please make a copy of this application in <br />preparation for this event A copy of this checklist must bo in the booth al all hours of <br />preparation apfRjporation Return original to festival coordinator three weeks prior to <br />this event. / d