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10.otentially hazardous foods below <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />OR <br />for soapy water, one for rinsing and one for a bleach <br />□ Detergent, bleach, and wiping clotl (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />12.hing facilities?tiFseparate from utensil wash within myw; <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 />14.Completed by: <br />Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />x <br />Propane T ank <br />Bleach and Water <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11EHD 16-02 <br />11/4/14 <br />,171 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Three deep tubs (basins 6-8 inchi <br />solution (one tablespoon of bleach per gal <br />I am providing the following for adequate h; <br />booth: <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground' <br />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <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 />Extra <br />Water <br />! <br />Soap and Water Rinse Water <br />Important** <br />.minimum), ur <br />in of water). <br />Fire Extinguisher <br />5-20 Gal <br />Hand wash Water <br />Names of responsible persons to be present in booth during all hours of operation: <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 />this event. —J" <br />_____________________________________________________- ( ■// -: ,• <br />Signature <br />I am providing the followir )ld temperature control for the cold holding <br />45°F (if food is used the following day, maintain below 41 °F temperature):