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03/03PAGEACE LITHO203478aJ12/18/2014 14:01 <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />0 Three compartment sink. <br />OR <br />J2Uetergent. bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution. <br />12. <br />13, <br />‘•Important** <br />14.Completed by; <br />Signature <br />Health Permit <br />Piqjiw kUrx) To-«9l9 <br />Soan CJ spentor <br />Biogen°roi»re Stove <br />/VC <br />]Soap and Waler <br />F>e Ejf.tnauls.'xsr <br />TEMP EVENT APPPage 6 of 11 <br />.1 <br />BHD 16-02 <br />7/28/10 <br />0Tce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />0'Refrigerator <br />□ Ice bath and tubs <br />San ttter txjcfcet- <br />Ueoct' S wulor lor <br />storif g vrpVig atotbs <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Terp. <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□^aper towels and pump-style soap container. <br />&eme w/Cn.iHHg <br />Dlsfi <br />Exira <br />wate- <br />s Sal wand wrcE <br />WaMawsrar Conieher <br />Garbage <br />Can <br />540 Gal <br />Hard ws»E Vrtte- <br />/ .......... <br />Ice Cooler <br />_________z <br />Title <br />|prM*-w Tan* <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 />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 />Names of responsible persons to be present in booth during all hours of operation: <br />Nf\e, ___________ <br />j Culling Bps-tl <br />pays i Food Cantab** mutt be ■ <br />sforwi 5 mans on ar re youna ■ <br />I Waiar | BHacr aro water