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10 <br />11. <br />OR <br />S Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />0, Water supply dispenser with warm water at a minimum of WOT (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />Ni13. <br />“Important** <br />Completed by: 14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Cuttlnn Board <br />BroachPropone Stove <br />Propane Tenk <br />Rinse Water Bleach and Waler <br />Page 8 of 11 TEMP EVENT APP <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth. <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 />Stern® w/CbalTing <br />Dish <br />5-20 G#L <br />Hindw-diWalw <br />Sanitizer budcet- <br />bleach & water for <br />storing wiping doths <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />O Refrigerator <br />® Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />EHD 16-02 <br />rwni/iR <br />{ <br />Exira \ <br />Water I <br />[gpiq- <br />Date <br />7 <br />Soap and Water Garbage <br />Can <br />Ice Cooler <br />fgrleer- <br />Title <br />D 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 pT'v’d'ng the fol'owing co'd temperature control for the cold holding of potentially hazardous foods below <br />45*7 (if food is used the following day, maintain below 417 temperature): <br />Iq^nes [esponsible persons to be present in booth during all hours of operation: <br /> : : | CZZ3 I - : <br />|4-L= <br />Ex!n If Btgi S Food Conttlnm must ba |y <br />stored Shebw off d the g round la <br />----------------- <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Soap dispenser