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10. <br />I am providing the following items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />Completed by: \15. <br />DateSie <br />iHealth Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />ru <br />t <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPago 8 of 11 <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />EHD 16 02 <br />7/14/15 <br />□ Water supply dispenser with warm water at a minimum of 100T (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 />□ 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 />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 tea Bags & Food Containers must ba <br />s torod 6 inchas off of tha ground/ <br />Slemo w/Chatfir <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />s.20 Gal. <br />Hand wash Waler <br />Names of responsible persons to/bj <br />r~l Refrigerator <br />jSIce bath and tubs <br />Propane Tank <br />I 7 <br />Rinse Water <br />Mr <br />__ Titled <br />“Important** <br />pj^ffi^sent in bo^h^ipng a^hours of o^gation^ <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />FJ^eterqent. bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this_event. Acopy-oHtais checklist must be in the booth at ail hours of <br />preparation apcToperatiory^Tfetum oriqlnahto festival coordinator three weeks prior to <br />this eyentr z->.] <br />/ Sanitizer bucket <br />/ b each 4 water for <br />/ F“ storing wiping cloths <br />noJ ------------------------------------X <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp.i m i' I—7 <br />Soap and Water <br />Extra <br />Water