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10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />OR <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 />S Paper towels and pump-style soap container. <br />13.Names of responsible persons to be present in booth during all hours of operation: <br />Owner 14.Completed by: <br />Title <br />IHealth Permit <br />aapor Hand T awols <br />Sood disponsor <br />CcKns Beard <br />BleachPropane Stove <br /> u <br />Rinse Water Bleach and Water <br />Fire Extinoulshor <br />Psge 8 of 11 TEMP EVENT APREHD 16-02 <br />7/28/10 <br />E] Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Stemo w/Choffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer eucket- <br />C oach & water tor <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Extra tee Bogs & Food Contomors must co <br />sto^xi 6 tncnes off of the ground' <br />Extra <br />Water <br />9/23/19 <br />DateSignature <br /> <br />••Important** 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 />Propano Tank <br />Soap and Water <br />S Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution. <br />□ Three compartment sink. <br />Sf 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 />Ice Cooler ■ ; <br /> <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-20 Gal. <br />Hand wash Water