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10, <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />□ Three compartment sink. <br />OR <br />12 <br />’’Important** <br />Completed by:14. <br />Signature Date <br />Health Permit <br />Paper Hand Towe’s <br />Soap dispenser <br />Bleach <br />a <br />Bleach and Water <br />r«e <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />■ <br />^SJce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />separate tub (bucket or basin) for the collection of rinse/wastewater. <br />JxCThree 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 cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41“F temperature): <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewaler Conumer <br />^54Detergent. bleach, and wiping cloths (cleaning towels). <br />,)>:ifJub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />I <br />Slwno WChurtwv; <br />Oush <br />5-20 GaI <br />Hand wash Water <br />SAnrtuBf bucfcel- <br />bteach & water for <br />storing wiping cloths <br />Extra <br />Water <br />Title <br />Extra to Bags & F<fod Cont&rwf must b* |Jt <br />sIcmwI 6 mcfios otfotlhe gtcucO1 I <br />"^ptTaoer towels and pump-style soap container. <br />13 Names of responsible persons to be presentirubooth during, all hours of operation:XA(xC I _____________ <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 />1 <br />M-.. ...^ <br />Garbage <br />Can <br />_ Ji L <br />I Sowp and Wmw Rmw Waw <br />----------------------------'IBooth must »e on <br />Concrete, Asphalt <br />Plywood ora Tarp. <br />____________J <br />I J .. <br />Ice Cooler <br />Cutting Hoard <br />Propane Stove