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Ip.JNo. 3280FEB/^kJ'.. 2017j 12_:_27PM pacjx^ Southwest FAX No. 1209982)^2 <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />E-Tnree compartment sink. <br />OR <br />12. <br />[upOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towel? <br />Soap <br />Cubing 0O?rd <br />BleachPropane Sw'/e <br />z <br />Ice Cooler <br />TEMP EVENT APPPage B of 11EHD 18-02 <br />Siecno w/Chaffina <br />Dish <br />□ Refrigerator <br />Q.lce'^ath and tubs <br />Extra <br />W,tor <br />Garbage <br />Can <br />O 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 />mDelergent, bleach, and wiping cloths (cleaning towels). <br />5 Gal Hand wash <br />WastcwHigr Container <br />5-2C Gfil. <br />Hand wash Wafer <br />Sanitizer buaJw- <br />bleach 4 water tor <br />storing wiping dOlh? <br />EQ 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 />[QzVt/ater-supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Title <br />l 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 />O^lbechests <br />□ Refrigerated truck <br />□ Other (specify) <br />la <br />Date <br />’"Important** <br />Fire Extinguishor <br />Propane TenK <br />------------------------k <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 />Booth must be on <br />Concrete, Asphalt, <br /> Plywood, or a Tarp. <br /> <br />Soap and Water Water <br />1 <br />—jTJ <br />&rf/u /cd Sap45 Food Can&inQrs musk be H <br />atofod 6 Inerts off of ground! Ji <br />□(Paper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />f 4A X : Vr-EV V _____________