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2:19PM P316 2013FAX NO.FROM- <ig. <br />1 am providing the following items within my booth for warewashing:11. <br />hree compartment sink. <br />OR <br />12, <br />14. <br />15.Completed by: <br />DateSignature <br />1 Paper Hand Tewete <br />Soap diaptn»*’ <br />Cutttvo Board <br />GinachPfQJXJfW Siovo <br />Propane TenX <br />Rinse We^rSoap and Water <br />2Fira ExUnsuliSiw <br />TEMP EVENT APPPsgeSofll <br />)I <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />IQ^rotergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />□ Ice chests <br />^■Refrigerated truck <br />□ Other (specify) <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one tor rinsing and one for a blasoh <br />solution (one tablespoon of bleach per gallon of water). <br />fcBnidMrbuckoV <br />bteichR writer for <br />stcrioa wiping ctothu <br />i <br />I <br />W$h <br />8 <3nl Hand vm»h <br />Container <br />Garbag* <br />Can <br />I <br />! <br />i <br />I <br />I <br />Refrigerator <br />□ Icq bath and tubs <br />5-20 Gal. <br />Hand v/cohWa tor <br />ijf mmb? <br />Beach srtdWdaf <br />t <br />Ice Cooler <br />10. . I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (II food Is used the following day, maintain below 41°F temperature): <br />Received Time May. 2. 20 1 9 3:21PM No, 4977 <br />EHD iB-02 <br />’'‘'Important’’' <br />i <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />rQ>?Vatersuppiy dispenser with warm water at a minimum of 100’F (l.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) tor the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />Names of responsible persons to be present In booth during all hours of operation: <br />Tewe’./g j 7^ - UoU-0344■ <br />-------- -----------—— <br />Booth must be on <br />Concrete, Aaphoft, <br />Plywood, or a Tarp. <br />Etdra fed & f^ood Cunlsai&cs ■ <br />stored 6 tnGhis ctl of (ho g/VUrtd? B <br />AB food vendor booths are sut^ect 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 al) hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br /> <br />Title Date <br />£>1121 <br />Wator