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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 />□ 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 />DateSignature <br />IHealth Permit <br />I Pap* HondTowalj <br />Bieazf.Prcpara Stave <br />J u <br />Propane Tank <br />Bwtf anc WalarSoap and Wrar Ri nee Water <br />Q <br />Ice Cooler <br />TEMP EVENT APRPaga 8 of 11 <br />Extra <br />Watar <br />EHD 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 />O 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 />Sumo wrCn*ffiog <br />0<W> <br />□ Refrigerator <br />□ Ice bath and tubs <br />5GM rtandwiwi <br />Waiieww* Cortaxw <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />Names of responsibj <br />3-hXY'\ i <br />Saniww txjoet <br />Mstf & water for <br />ttenng wipmg aoni <br />phce chests <br />^C^Ttefriqerated truck <br />□ Other (specify) <br />Eitra lee Bags 3 Food Conttfoan must Oe ■ <br />I stotad Smcfwsotfoftnegmunff’ ■ <br />"Die oersons to be present in booth during all hours of operation: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 operatiorK Return original to festival coordinator three weeks prior to <br />this event-\ / ) <br />5-20 Gat <br />r- Hand *Ba Water <br />Scap aspenwr I , . . \ <br />Fee Ejdtncuaher I <br />| Cutting Board j <br />5/ 2 ^/1