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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 /> Three compartment sink. <br />OR <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />[yfTub to store wiping cloths in bleach solution. <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 />0"Paper towels and pump-style soap container. <br />13. <br />OWNER 9/13/2314.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towols <br />Soap dispenser <br />BlenchPropane Stove <br />Propane Tank <br />RJr.se Wotor <br />Fire Extinguisher <br />Page 8 of 11 TEMP EVENT APPEHD 16-02 <br />7/28/10 <br />Names of responsible persons to be present in booth during all hours of operation: <br />JERROD "CHEF JAY"LAKEY <br /> 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra /co Bags & Food Canlalnors must bo <br />storod 6 incnos off ot tho ground! <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. <br /> Refrigerator <br /> Ice bath and tubs <br />5 Got Hand wash <br />Wosiowoter Contolnor <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach wotor for <br />storing wiping cloths <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />Stomo w/Chafflng <br />Dish <br />Extra <br />Water <br />\ <br />Bleach end Water <br />• I ........-I <br />Soup and Wotor <br />**lm porta nt** <br />. ..|..............................—. ■ <br />isJ <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 />Ice Cooler ;;