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-I <br />I f <br />below <br />10. <br />itensil <br />and one <br />11. <br />OR <br />12. <br />13. <br />**lmportant’ <br />Completed by:14.Signature <br />Health Permit Paper Hand Towels <br />Cutting Board <br />Bleach <br />Propane Stove <br />7k- <br />Bleach and Water <br />Fire Extinguisher <br />7 <br />Soap and Water <br />1__ <br />Rinse Water <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water lor <br />storing wiping cloths <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />- — J of Polen <br />irature)- <br />Ice Cooler <br />— Iz <br />Soap dispenser 1 <br />Booth must be on <br />Concrete, Asphalt- <br />Plywood, or a Tan? <br />x. __________ <br />□ Refrigerator <br />utensil wash within my <br />ontrol for the coW holding <br />■on • -iftF tempo'■— <br />itially hazardous foods <br />subject to inspection. “rb^thVaU hours of <br />Title Daxe <br />! 5-20 Gal. <br />Y" I Hand wash Water <br />entai Health Depart^ent <br />Environme <br />Propane Tank <br />---------------------J <br />for a bleach <br />.,,00-F (I. MO <br />..............—--------------------------- <br />------------------------------- -------------------------------------------------------------------- ‘ <br />All food vendor booths are <br />preparation for this event, <br />preparation and operation. <br />thi^event • ' * <br />san,jmodin <br />gj ice Chests Q |ce bath and tubs <br />Q Refrigerated true <br />0 Other (specify)---------- <br />ss;S2S*ss.£';S::,w <br />bU ' <br />, am providing the followmg for adegu <br />booth: