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10. <br />11. <br />OR <br />12. <br />'aper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />signature <br />Paper Hand Towels <br />Propane Stove <br />Propane Tank <br />Soap and Water Rinse Water Bleach and Water <br />Fire Extinguisher <br />Page 8 of 11 TEMP EVENT APR <br />EHD 16-02 <br />08/01/16 <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 galli <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />Ion container with spigot). <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Ice Cooler <br />Health Permit 3 <br />~— <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />____________> <br />^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />“Important** All food vendor booths <br />preparation <br />preparation <br />this events <br />tor soa‘,y water' °"e ,or rinsi"9 a"a °"ea bfea<* <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />Mjub to store wiping cloths in bleach solution. <br />I-...i....... .............. . ....... ~ '' <br />Extra Ice Bags & Food Containers must be i <br />stored 6 inches off of the ground! <br />n,- ar.e subject to insPection. Please make a copy of this application in <br />ir this event. A copy of this checklist must be in the booth at all hours of <br />iioperation. Return original to festival coordinator three weeks prior to <br />Title J Date 1 <br />Soap dispenser <br />Bleach