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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 />E-iree compartment sink. <br />OR <br />12. <br />13. <br />.y\Completed by:14. <br />Health Permit <br />Paper Hand Tvwel? <br />Soap dispenser <br />CuHir»g 5o?rd <br />BleachPropane Stove <br />J* <br />Propane TenK <br />Ice Cooler <br />TEMP EVENT APPPage B of 11EHD 18-02 <br />Slarno w/cnafl(na <br />Dish <br />Extra <br />Wetor <br />5-20 Gal. <br />Hand waah Water <br />Garbage <br />Can <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45^ (if food is used the following day, maintain below 41OF temperature): <br />O-lt^chests <br />Q Refrigerated truck <br />□ Other (specify) <br />lew Food Ccn^inafy be <br />ate fad 6 /ncn^-c off of if>a groUndl <br />Sanitizer buaJW- <br />bleach Z. water for <br />i to ring ^Ipinjl cJblhs <br />Tub 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 />Q^/ater-supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />5 Qal H&nd wash <br />Container <br />Title <br />c^nfjd Waiter <br />X-DJ' ~l <br />Date <br />^Important’* <br />□ Refrigerator <br />□.Ic^bath and tubs <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 />K t/ZI ^ <br />Signature <br />D Three deep tubs (basins 6-3 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 />It].Detergent, bleach, and wiping cloths (cleaning towels). <br />[3y6ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />uj Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_______' _ 1 i;'V\ ________. . ..— <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, oraTatp. <br /><______________I ■ l -jJ <br />Soap and Water <br />FreExtinfluizhaf | <br />X <br />Bleach and Water | | <br />■