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potentially hazardous foods below <br /> <br />10. <br />I am providing the following items within my booth for warewashing.11. <br />□ Three compartment sink. <br />OR <br />12. <br />13. <br />14. <br />Important** <br />Completed by: 15. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinpuislier <br />J <br />Page 8 of 11 TEMP EVENT ARP <br />Ice Cooler <br />EHD 16-02 <br />7/14/15 <br />® Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Stemo w/Ctiaffino <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water (or <br />stonng wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <br />I am providing the following items within my booth for the <br />O Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />5-20 Gal <br />Hand wash Water <br />Title Date <br />Soap and Water Rinse Water <br />sanitary cleaning of food preparation utensils: <br />/ <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 /> <br />Signature <br />I am providing the following cold temperature control for the cold holding u. <br />45°F (if food is used the following day, maintain below 41 °F temperature): <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 />Extra Ice Begs t. Food Containers must be H <br />stored 6 inches oH ol the ground1 | <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth. <br />O' Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Cutting Board