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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 />Q 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 />operation:13. <br />“Important** <br />14.Completed by: <br />Title <br />Health Permit <br />Piper HondToweU <br />BiaacrPrepare Stove <br />it <br />Bead- anc Water <br />tan Extino-juforQ <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°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 />Extra 'co Bays « Prxx/ Cantame'S must t>o <br />snnd 6 mates at of tne ground' <br />Slenvo w/Chifflng <br />Osn <br />□ Refrigerator <br />Q Ice bath and tubs <br />5 Gai Hand wash <br />Wastewater Cortarnor <br />Garbage <br />Can <br />Sam'jzer puoat <br />pieacf 4 water tor <br />stenng wipwxg dors <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />J^lce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Extra <br />Water <br />5-20 Gai <br />Hand wash Water <br />£ <br />Soap and Water <br />Scao dispenser <br />IT <br />R.naa Water <br />Date <br />Cuttinq Board I <br />I Propane Tank <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 /> '7^— [ <br />Signature <br />Name£,of responsible persons to be present in booth during all hours of