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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 /> Three compartment sink. <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 100ppm. <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 />13. <br />Date <br />Completed by: 14. <br />Signature <br />Health Permit <br />Paper Hand Toweli <br />Cutting Board <br />Bieacr.Prepare Stove <br /> it x <br />Fire EzBnffjjhar <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />Soap andWtter Rinee Wuer <br />EHD 10-02 <br />11/4/14 <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 /> 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 />& fra la Baps 4 Food Confamers mutt Do <br />storwd 6 Kienes on of me yoona' <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 />Slemo w'O^rtng <br />Or*ft <br />Extra <br />Water <br />SGai Hand wain <br />Waattnvaier Coctamor <br />Garbage <br />Can <br />Saniwer Buoat Waact i water for <br /> itortng wipng aoths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />Ice chests <br /> Refrigerated truck <br /> Other (specify) <br /> Refrigerator <br />H Ice bath and tubs <br />Cuvier <br />Title <br />(J <br />\— <br />Baacr and Watar <br />| Propane Tan* <br />5-20 Gal <br />r- Hand *asn Watar <br />Scaq diipanwr —\ <br />Names of responsible persons to be present in booth during all hours of operation: <br />yO ftVlA ___________________ <br />“Important**