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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 100ppm. <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />12. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soao container. <br />Names of responsible persons to be present in booth during all hours of operation:13. <br />Important** <br />/Date ' <br />14. <br />Health Permit <br />Pit« Hand Towtll <br />Prcpar* Slave <br />Prco«r« Tann <br />Bwcr. am'NMi <br />Fn Edinguibor <br />Ice Cooler <br />V <br />TEMP EVENT APPPage 8 of 11EHD 18-02 <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 />0 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.Ti ta 34QJ J Pood Confs.<M< J rnusf <br />trtxwtf 3off#,?.<> jzowW <br />Sumo wiCraflng <br />Dsn <br />0 Refrigerator <br />0 Ice bath and tubs <br />5 Hand <br />WailowMar Coct><vx <br />Garbage <br />Can <br />Sdnazar Buoat <br />tMacr l «auar tor <br />ttcnng dori <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />0 Ice chests <br />0 Refrigerated truck <br />0 Other (specify) <br />Ejrau <br />W«ar <br />Completed by: C <br />Title <br />QT <br />R.-iMWa«r <br />—=T <br />Soao and Witer <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my boo,h: A <br />0 Water supply dispenser with warm water at a minimum of 100aF (i.e. 5-20 gallon container with spigot). <br />I <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 />£ Gx.----- <br />Signature <br />5-20 GJ« <br />r- Hard «tsn A a’or <br />Scac I -------- \ <br />Cifftna Scare