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10. <br />OR <br />12. <br />i <br />13. <br />*‘Important** <br />14. Completed by; <br />Health Permit <br />Pnpor Hand TwtfJ <br />SoapiodWitef fans# Water Bfoacti and Wilw <br />Fire ExftwWxr <br />PagaSof 11 TEMP EVENT APPEHD 1002 <br />7/2W10 <br />ai/B lOBBtQt&FtKdComtllKtSnMba <br />stored fl Irxhua on ortho gnundi <br />St emo wfChiffing <br />(Xth <br />□ Refrigerator <br />□ Ice bath and tubs <br />s<3>l«endwa<h <br />WnXcMlwConlHner <br />Garbage <br />Can <br />Booth must he on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />solution (one tablespoon of bleach per gallon of water). <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths In bleach solution. <br />EMr« <br />W»l«r <br />Sirfthirbodcal- <br />blMch & water-for <br />« Urfng wiping cto lilt <br />I Propene Tefik <br />| CutVogBoanf | <br />Propane Stove n <br /> <br />Title <br />11. lam providing the following Items within my booth for (he sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />( MO Get <br />r- Hand wash Waler <br />I Soapdispensw I _____\ <br />I am providing the following cold temperalure control for (he cold holding of potentially hazardous foods below <br />45°F (if food Is used the following day, maintain below 41 ’F temperature); <br />(//ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />| Blooch <br />9.Til1?/ d?ePut^s _^a8l9S e-SJnches minimum), one for soapy water, one for rinsing and one for a bleach <br />I am providing the following for adequate hand washing facilities, bufse^ra^fromutensil wash wilhf^my <br />booth: <br />[Ef Water supply dispenser with warm water at a minimum of 100T (l.e, 6-20 gallon container with spigot). <br />E'bne separate tub (bucket or basin) for the collection of rinsefwastewaler. <br />[?fpaper towels and pump-style soap container. <br />present In boo^i d^ng aljhpZs of operation: <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, A <br />Ice Cooler || <br />Names of respons^ile pe^ ons^ob^i^^