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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 />hree compartment sink. <br />OR ' <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring 100ppm. <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 />13. <br />Important** <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper HondToweU <br />BiaaaiPrepare Slow® <br />it <br />BMcr anc '/rater <br />ExanffjishorG <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <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 qF 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 />Eitn ts S Fooa Cofittmen mitt t>o <br />rtorwd 5 mtMs off of me gmontl' <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />Extra <br />Watar <br />Garbage <br />Can <br />Sanitizer PuOBt <br />Weaclt i wotor tor <br />stonng wifxng aotru <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify)__ <br />Stemo w/Cnaffing <br />Ost <br />SGal Hand wain <br />Wutewater Contamer <br />□ Refrigerator <br />□ Ice bath and tubs <br />iXC-_________ <br />± <br />R im 7.’a4« <br />— <br />Soao end Water <br />Scap dlip«n»r <br />Cutting Board | <br />I Pro sane Tank <br />Names of responsible persons to be present in booth during all hours of operation: <br />_______________ <br />I Title Date <br />5-20 Gai <br />Y" Hand wash Water <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event, <br />preparation and operation.' <br />/fils event- (