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ULC-U-tMlb l-rom:io-( ryu Haee:JZJ <br />10. <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />OR <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br />13. <br />14. Completed by: <br />Health Permit <br />i P^FerH.wdTo-.vals <br />Scap dispense* <br />Cufflr.n Eoa.-fl <br />BleachFropwp &0»a <br />Propane T&r>k <br />B teach ond Wstar <br />Hre Exrnautshw <br />TEMP EVENT APPPajjc 8 of 11EHD 1&-O2 <br />7/28/10 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />r <br />[0 Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot), <br />[vf One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q/f Paper towels and pump-style soap container. <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 />5-20 Gal. <br />Haxdwaih Waler <br />Booth must be on <br />Concrete. Asphalt. . <br />Plywood, or a Tarp. <br />btcmow/Ctpfi'r.g <br />Dish <br />[tf] Refrigerator <br />□ Ice bath and tubs <br />Exira <br />water <br />5 GnJ Hand wash <br />Wes’.ev^ncrContaner <br />Garbage <br />Can <br />SomiZer buik&t- <br />tleadi i water fof <br />slorihg^pfriaclOlM <br />7 <br />Ice Cooler <br />.... I <br />Sw and Water <br />iryL^n^-ri <br />Title <br />i2//2//6 <br />'Date <br />/ . <br />RtaaeWeter <br />“Important** <br />Signature <br />□ Three compartment sink. <br />QT] 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />1 am providing the following cold temperaturo 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 />/ <br />13 foe chests * <br />□ Refrigerated truck <br />□ Other (specify) <br />z!a ed 6 ultSHM off of mo gicandl ■