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10.Dtentially hazardous foods below <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, a <br />□ Tub to store wiping clotlAin bleach solution measuring 100ppm. <br />12. <br />13. <br />“Important** <br />Completed by: 14. <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />zzzt <br />Soap and Water <br />EHD 16-02 <br />11/4/14 <br />0 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/Chaffing <br />Dish <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 />C Refrigerator -4-vvjC— <br />□ Ice bath and tubs <br />Extra <br />Water <br />5-20 Gal <br />Hand wash Water <br />Extra Ice Bags & Food Containers must be I,! <br />stored 6 inches off of the ground1 itS <br />________ <br /> <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 /> <br />Signature Date <br />I am providing the followin Id temperature control for the cold holding <br />45°F (if food is used the following day, maintain below 41°F temperature): <br />□ Water supply dispenser withVarm water at aAninimum of 1692^1^5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the cZlIedtionojXise/wastewater. <br />□ Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />j Health Permit p <br />□ Three deep tubs (batsins\6-8 inches YninirRum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespd^ji of bleach per gi Ion oXwater). <br />wiping cloths (' kleaijing tov>KL^ <br />□ Test strips to measure ^anitatiomtevsls for bleach solution measuring lOOppm.