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10. <br />11. <br />OR <br />14. <br />15.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BitschPropane Sieve <br />Biondi anti Wyler <br />Fire ExtinguisherQ <br />Page 8 of 11 TEMP EVENT APR <br />^Refrigerator <br />□ Ice bath and tubs <br />EHD 16-02 <br />7/14/15 <br />□ Three 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). <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <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 />Extra lea Bagj & Food Contain muti be <br />stored 6 Inches off of the grsvwf <br />Garbage <br />Can <br />I am providing the following items within my booth for warewashing: <br />t^Three compartment sink. <br />Stemo w/Chaff ng <br />Dsh <br />Extra <br />Waler <br />5-20 GaJ. <br />Hand wash Water <br />Sanitizer bucket <br />bleach & water for <br />storing wiping cloths <br />5 Gal Hand wash <br />Wastewater Container <br />ice Cooler <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />J <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />“Important** <br />Date <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 />(./V/Vk . A <br />zT^xSIgnature <br />Names of responsible persons to be present in booth during all hours of operation: <br />j Propano Tank <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />Sc^p and Walw Rlw Wr*f