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10, <br />I am providing the following Items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />12. lam 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 />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth; <br />15. Completed by: <br />Title <br />Paper Hand Towels <br />Soap dispenser <br />CtMihfl Board <br />BleachPropane Stove <br />H f. <br />Fire Exllrwuljtiwa <br />Ice Cooler <br />TEMP EVENT APPPaga 8 of 11EHD 18-02 <br />7/14/15 <br />□ tee chests <br />□ Refrigerated truck <br />□ Other (specify) <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 />Siemo w/Chafflno <br />DWi <br />SanHIzar buctet- <br />bleach & water for <br />storing wJpfcig dollw <br />□ Refrigerator <br />Ice bath and tubs <br />il <br />6 Gal Hand wash <br />Wastewater Container <br />S-20 Gal. <br />Hand wash Waler <br />Garbage <br />Can <br />Health Permit <br />( Extra \ <br />Walsr I <br />“Important** <br />Soop and Water <br />iff ■ <br />Extra Ice Bags & Food Containers must be <br />stored G Inches off of the ground! <br />Date <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 />■ 14. Names of responsible persons to be present in booth during all hours of operation: <br />VA-XtS _________ _______________________________ ______ <br />.. .. V _ ____________________1------------------- - <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 /> <br />Signature <br />O Water 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 (he collection of rlnse/wastewater. Paper towels and a pump-style, soap <br />container. <br />Propane Tank <br />————X <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />______________/