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i <br />10. <br />i <br />11. <br />i <br />OR <br />deep tubs (basins 6-8 inches minimum), one for so< 3y water, one for rinsing and one for a bleach <br />12. <br />13. <br />14.Completed by: <br />Cutting Board <br />Propane Stove Bleach <br />a Tarp. <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />i <br />Page 8 of 11 I <br />I <br />Soap and Water <br />es, but separate from utensil wash within rny <br />EHD 16-02 <br />7/28/10 <br />O' Water supply dispenser with warm water at a minimum of 10 °F (i.e. 5-20 gallon container with spigot). <br />Q'One separate tub (bucket or basin) for the collection of rinse/ /astewater. <br />Q'Paper towels and pump-style soap container. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />All food vendor booths are subject to inspec <br />preparation for this event. <br /> Refrigerator <br /> Ice bath and tubs <br />S Gal Hand wa <br />Wastewater Cont tier <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, ort <br />5-20 Gal. <br />Hand wash Water <br />Stemo w/Chaffing <br />Dish <br />TEMP EVENT APR <br />I -BI <br /> Three compartment sink. <br />H'Three <...................... <br />solution (one tablespoon of bleach per gallon of water). <br />Q'Detergent, bleach, and wiping cloths (cleaning towels). <br />QTub to store wiping cloths in bleach solution. <br />Blet :h and Water <br />— <br />JI <br />Soap dispenser <br />Sanitizer bucket­ <br />bleach & mter or <br />storing wiping ctyfiis <br />: r - <br />< Cc ijr <br />Title <br />I am | <br />45°F (if food is used the following day, maintain below 41 °F te nperature): <br />Qlce chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)______________________________ __________ <br />I am providing the following items within my booth for the sanitai / cleaning of food preparation utensils: <br />Names of responsible persons to be present in booth during all I ours of operation: <br />; i I <br />——— <br />Ice Cooler <br />“Important**on. Please make a copy of this application in <br />A copy of this feiecklist must be in the booth at all hours of <br />preparation and operation. Return original o festival coordinator three weeks prior to <br />this event. <br />A <br />\: <br />_______ <br />Paper Hand To rets <br />I am providing the following for adequate hand washing fadli <br />booth: <br />I- <br />[ <br />providing the following cold temperature control for the old holding of potentially hazardous foods below <br />Signature <br />id <br />Garbage <br />Can <br />Health~Permit~