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( ' <br />10. <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 />12. <br />13. <br />thi: <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguishera <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />I <br />Soap and Water Rinse Water <br />EHD 16-02 <br />11/4/14 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41°F temperature): <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 for <br />storing wiping cloths <br />Booth must be on <br /> Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemo w/ChaffingDish <br />^Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />*l^jTub to store wiping cloths in bleach solution measuring lOOppm. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I Extra \ <br />I Water <br />^*Tlce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />KjjThree 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 />^Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />Propane Tank <br />Lr/ <br />**lm portant**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-awl operation. Return original to festival coordinator three weeks prior to <br />sVent./z <br /> i F Signature Z—Title <br />ater 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 />N. <br />Date <br />ames of,.responsible persons to be present in booth during all hours of operation: <br />WX) ix\ 0IfMA.»_____