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8. <br />Kl|-|X <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:9. <br />□ Three compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />10. <br />□ Water 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 />□ Paper towels and pump-style soap container. <br />13. <br />important** <br />Completed by: 14. <br />Signature <br />Health Permit <br />I Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BieachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />3Z <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify)__ <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 Bags & Food Containers must be <br />stored B Inches otf of the ground! <br />Stamo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following cold temperature control for the cold holding of pounitially hazardous foods below <br />45°F (if food is used the following day, maintain below 41°F temperature): <br />Saratizer buckat- <br />bteach 8. water for <br />storing wiping cloths <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water I <br />Titie Date <br />I <br />Soap and Water <br />Ice Cooler j ' <br />Names of resppnsib|e persons to be present in booth during all hours of operation: <br />ScCkKi_________ __ ____________________ <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 />Rinse Water <br />| Propane Tank