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10. <br />OR <br />i <br />13. <br />14.j <br />“Important** <br />Completed by:15. <br />Signature <br />Ting <br />Paper Hand Towels <br />CuWnfl Board <br />QleachPropane Sieve <br />Bleach and Waler <br />Ice Cooler <br />1 <br />TEMP EVENT APPPage a ol 11 <br />J <br />i <br />EHD 18-02 <br />7/14/15 <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />Exira <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Waler <br />Gatbage <br />Can <br />Booth must be on <br /> Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Sanllizor bucket­ <br />bleach & water for <br />storing wiping doUis <br />/ Exira Ice Bags & Food Conlainers most be ’ <br />stored 6 inches oil of the ground! i <br />Title <br />Health Permit <br />,5-e-/7 <br />Date <br />11. lam providing the following Items within my booth for warewashing: <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 />12. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils; <br />Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />(3 Refrigerator <br /> Ice bath and tubs <br />iiGrnovMCi <br />'"'Dish <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth. <br />SlWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <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 41T temperature): <br />Propane Tank <br />Soap dispenser | --------- <br />|__Fire ExlInflUBher <br />Names of responsible persons to be present in booth during all hours of operation: <br />_ <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 prlpr_tg <br />this event. z? <br />Soap and Water Rinse Waler