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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, 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 />Names of responsible persons to be present in booth during all hours of operation:13. <br />14.Completed by: <br />p <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />fl Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />11/4/14 <br />□ 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 />Extra Ice Bags & Food Containers must be <br />stored 6 inches oft of the ground1 <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 />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer Ducket­ <br />bleach 8. water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />5-20 Gal <br />Hand wash Water <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 />Title <br />Soap and Water Rinse Water <br />T-//-/7 <br />Date <br />Health Permit <br />iu S -3 c > I x s <br />Signature <br />‘‘Important** <br />Propane T ank <br />------------------------1 <br />I am providing the foliowin Id temperature control for the cold holding <br />45°F (if food is used the tunuwing day, maintain below 41°F temperature).