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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 />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />□ Tub to store wiping cloths in bleach solution measuring lOOppm. <br />12. <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 />Names of responsible persons to be present in booth during all hours of operation:13. <br />Important** <br />14.Completed by: <br />Date <br />Health Permit <br />Paper Hand Tow«ll <br />Bl "a srPrepare Store <br />u <br />B»*o- are Water <br />G <br />Ice Cooler <br />TEMP EVENT APRPaae B at 11 <br />— t <br />Soap and Water <br />± <br />R. me Water <br />□ Three compartment sink. <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 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />EiItb tea Baps S Food Containers must be <br />stored 5 mcf'et OfCfttie ground1 <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 />□ Refrigerator <br />□ Ice bath and tubs <br />Garbage <br />Can <br />Saniuzet Pucxet <br />4 waiar for <br />stenng «|wj =oc-5 <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />EHD 10-02 <br />11/4/14 <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Siamo w/Cn<fflng <br />5 Gai Hand watfi <br />Waslowaief Contaxw <br />( Extra \ <br />Wator <br />Signature <br />I Propane TanK <br />| Cutting 3agrq | <br />Title <br />5-20 Gai <br />r- Hand wasn Water <br />Scap dtjpenwr — . ■ \ <br />Fira Exfingunher |