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14. Completed by: <br />Signal <br />Health Permit <br />1 <br />Paper Hand Towels <br />Propane Slove <br />I Li‘" i <br />a Fire Extinguisher <br />TEMP EVENT APPEHD 16-02 <br />07/28/10 <br />Sterno w/Chatfing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach S water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Extrn tea Bogs & Food Containers must be <br />stored 6 Inches oil of the ground' <br />£)c*Jr? <br />Title <br />5-20 Gal. <br />Hand wash Water <br />5 <br />Date <br />Ice Cooler ! <br />Bleach <br />I Propane Tank <br />**Important** <br />I Soap dispenser I <br />All food vendor booths are subject to inspection. Please make a copy of this application <br />in 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 <br />to this event. <br />rr’SLZ <br />/ <br />Soap and Water <br />ZU U —JI—J <br />10.J am providing the followin' ’d temperature control for the cold ho. g of potentially hazardous foods <br />■oelow 45 degrees Fahrenheit (ji food is used the following day, maintain below 41 degrees Fahrenheit): <br />[XI Ice chests [ ] Refrigerator [ ] Refrigerated truck <br />[ ] Ice bath and tubs [ ] Other (specify): <br />11.1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />[ ] Three compartment sink <br />OR <br />M 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 />[ ] Detergent, bleach, and wiping cloths (cleaning towels). <br />[ ] Tub to store wiping cloths in bleach solution. <br />12.1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[KJ Water supply dispenser with warm water at a minimum of 100 degrees Fahrenheit (i.e. 5-20 gallon <br />container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^1 Paper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: <br /> /\h <br /> <br />I Cutting Board | <br />Rinse Water I