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10. <br />11. <br />Only disposable utensils are used <br />OR <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />12. <br />0 Paper towels and pump-style soap container. <br />13. <br />Important** <br />14.Completed by: 2016 <br />Signature <br />Health Permit <br />Paper Hanc Towels <br />Soap d sperser JCuttr® Board <br />Propane Stove Bleach <br />Propane Tank <br />Fire Extinouisher <br />Ice Cooler • <br />Page 8 of 11 TEMP EVENT APP <br />EHD 18-02 <br />8/1/14 <br /> Test strips to measure sanitation levels for bleach solution measuring 100ppm, <br /> Tub to store wiping cloths in bleach solution measuring 100ppm. <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify) Not applicable <br />Gxtra <br />Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Slemo w/Chaffina <br />Dish <br />S Gal Hard wash <br />Wastewater Ccrttaine' <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer txtcket- <br />Dieach & waler for <br />storing wiping ctcths <br />Owner <br />Title <br />Extra ice Bags & ~coc Containers must be I <br />stored 6 inches off of the ground! <br />Dec 20, <br />Date <br />Names of responsible persons to be present in booth during all hours of operation: <br />■M-ic.bael Carey - Food Handler Certificate 2014-1085899 <br /> <br />LU 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 items within my booth for the sanitary cleaning of food preparation utensils: <br /> Three compartment sink. Not applicable. <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 />Bleach and Waler | <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for thb 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. / /J I I /] / ~ -------- <br />Sc up and Waler Rinse Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: 3