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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 />[25 Three compartment sink. <br />OR <br />12. <br />13. <br />Important’ <br />^tJn <br />bate / <br />Completed by: 14. <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Soard <br />BleachPropane Stove <br />u <br />Bleach and Water <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />11/4/14 <br />0 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 />I am providing the following, Jd temperature control for the cold holding >. otentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />□ Ice chests <br />H Refrigerated truck <br />□ Other (specify) <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 />Exfra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground1 <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chaffing <br />Dish <br />(3- Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal <br />Hand wash Water <br />Extra <br />Water <br />/ - <br />Ice Cooler 1/ <br />Title <br />- —T <br />Soap and Water Rinse Water <br />| Health Permit Ji <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 1 DOT (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^5 Paper towels and pump-style soap container. <br />Names of responsiblejoersons to be present in booth during all hours of operation: <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 />tfii^, ev^Zit. . <br />Signature <br />Propane Tank <br />-------------------------1