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10- <br />I am providing the following items within my booth for warewashing.11. <br />□ Three compartment sink. <br />OR <br />12. <br />13. I am <br />14. <br />Completed by:15. <br />Signature <br />Health Permit <br />PagMM H*r*d Sowwls <br />SCOP difiVVASAT <br />Bleach <br />Prepare Stu-v* <br />Rrpana Tank <br />ENtMtdT and WofcorRinse WaterSoap and WW <br />TEMP EVENT APPP^ige fi O? 11E.HD 16 02 <br />7/14/15 <br />I am providing the followir <br />45°F (if food is used the <br />®Jce chests <br />□ Refrigerated truck <br />O Other (specify) <br />Id temperature control for the cold holding or —'tentially hazardous foods below <br />/ring day, maintain below 41 “F temperature): <br />O Refrigerator <br />0$ Ice bath and tubs <br />5 Gal lEb’td wsS’h <br />WaetiSMiatBT CohlaeAnr <br />ition and operation. Return original to festival coordinator three weeks prior to <br />ant <br />fc-jura lice <5. f-oed Cc*«rf<S^eni must t>6> <br />siortHf 6 tnohw off of fchfr gsreunu'’ <br />Stcjno w'ChaTTlng <br />EX# <br />5-20 Gai. <br />ftend wtjRh Water <br />San&c&it bunn-ct <br />btemh A water fix <br />storing wptivj doefts <br />___ (d <br />Title <br />4ln| >h <br />Date <br />“Important** <br />Ice Cooler jj <br />Garbage <br />Can <br />All food vendor booths are subject to inspection. Please make a copy of Unis application in <br />preparation for this event. A copy of this checklist must be in the booUt at all hours of <br />prepaj ~ ...... <br />ttiii <br />— L <br />providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />0 Water supply dispenser with warm water at a minimum of 100“F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rlnse/wastewater. Paper towels and a pump-styfe soap <br />container. <br />-------—-------------- <br />Booth must be cn <br />Concrete, Asphalt, <br />Plywood, ora Tarp <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 items within my booth for the sanitary cleaning of food preparation utensils. <br />[)H Detergent, bleach, wiping cloths (cleaning towels), arid a tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />A erVa ( Va d <7- »__rMT? dot________