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10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />S^fhree compartment sink. <br />OR. <br />QlDetergent, bleach, and wiping cloths (cleaning towels). <br />UJ-Tub to store wiping cloths in bleach solution. <br />12. <br />HEfWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />3^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[Reaper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Health Permit <br />1 Paper Hand Towels <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVEMT APPE HD 16-02 <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 />S^ce chests . <br />□ Refrigerated truck <br />□ Other (specify) <br />Q^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 />Sterno w/Chnlling <br />Dish <br />EZh^efrigerator <br />□ Ice bath and tubs <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8 water for <br />storing wiping cloths <br />5 Gal Hand wash <br />Wastewater Container <br />Extra <br />Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />TitleSignature <br />_z <br />Soap and Water <br />7 <br />Rinse Water <br />•‘Important** <br />I Propane Tank <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 />Names of responsible persons to be present in booth during all hours of operation: <br />WaJcC L-AHSEa) <br />Soap dispenser I ----------- <br />Extra Ice Barrs S Food Containers must be I <br />I stored 6 inches olt ot the ground! I <br />I Cutting Beard