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10. <br />I am providing the following items within my booth tor the sanitary cleaning ot loot! preparation utensils:11. <br />(3 Three compartment sink <br />OH <br />E) Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />□ Water supply dispenser with warm water at a minimum of 100 F (i.o. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinsc/wastewaler. <br />0 Paper towels and pump-style soap container <br />13. <br />“Important** <br />Completed by 14. <br />Signature <br />Health Permit <br />i <br />Culli'Si Bc.aci <br />(3e.;i ‘1Piur.-.iH' Sieve <br />0IIII <br />I'loini'K’ r.w <br />Ri'i:; ' W..i( I 'i.: <br />’?• FVFNTA--EHD • <br />□ Ice chests <br />□ Refrigerated truck <br />H Other (specify) <br />I am providing the following cold temperature control tor the cold holding of potentially hazardous foods below <br />45 F (if food is used the following day, maintain below 41 F temperature): <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 />S'finti v. avilliiH) <br />Distl <br />BlXZh IT uS Lv <br />Concrete. Asphalt <br />Piyv.ood. ci a Tarp <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />0 Refrigeratoi <br />□ Ice bath and tubs <br />Garbage <br />Can <br />b Gui II.f«H a .'i <br />5 X> G :l <br />Names of responsible persons to be present in booth during al! hours of operation <br />v /> ('ir (3 ■' ________________________________ <br />Title <br />J <br />I r z <br />Date <br />.■ <br />[xir.i hi’ ••• FIinust ts” <br />‘■’vuil(i't. i " • ‘ <br />I Fire Ek’i v.c r <br />f| Ice Cooler