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9. <br />□ Other (specify) <br />10.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Q Three compartment sink. <br />OR <br />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />11. <br />Q Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) forthe collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />12. <br />04-10-2023Owner <br />13.Completed by: <br />Title Date <br />\Health Permit <br />Paper Hand Towels <br />Soap dspenser <br />Cutting Board <br />BleachPropane Stove <br />0D <br />Page 8 of 11 TEMP EVENT APP <br />7“ <br />1________ <br />Rinse Water <br />EHD 16-02 <br />O&'OI/ie <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Names of responsible persons to be present in booth during all hours of operation: <br />Karen labar <br />Q Ice chests <br />□ Refrigerated truck <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches oft of the ground! <br />Sterno wChaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & waler lor <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora 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 />REC-001-B <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- Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />~l <br />I <br />I <br />Ice Cooler j <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 />eSigned vt» SeamleeaDocg.com <br />•‘Important** <br />Key: 3e31 a<1f435<5c2fa<51 e7t>ec3^e7d0 ja|^^£||’0 <br />Garbage <br />Can <br />I <br />_____L <br />Soap and Water <br />Propane Tank—I =51 <br />_Fire Extinguisher