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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 />12. <br />J2^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation:13. <br />"Important** <br />Completed by: 14. <br />Signature Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Pre Extinguisher <br />Pania fl nf 11EHD 16-02 <br />t^Uce 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 />'^3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <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 />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping cloths <br />Extra <br />Water <br />Date <br />-^Detergent, bleach, and wiping cloths (cleaning towels). <br />•^Tub to store wiping cloths in bleach solution. <br />A\ <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 />preparafion and operation. Return original to festival coordinator three weeks prior to <br />this event " '' <br />Soap and Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />'BW I rx'’ <br />ask. <br />I I <br />'7 <br />Ice Cooler : < <br />Propane Tank <br />-------------------------H <br />Rinse Water Bleach and Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />------- I I <br />Garbage <br />Can <br />OR <br />^^fhree 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).