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10. <br />11. <br />OR <br />Q^Petergent, bleach, and wiping cloths (cleaning towels). <br />3 Tub to store wiping cloths in bleach solution. <br />12. <br />3 Paper towels and pump-style soap container. <br />13. <br />14.Completed-byr— <br />Date/ <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />Propane Tank <br />J <br />Soap ano Water Bleach and Water <br />Fire Extinguisher <br />Page 8 of 11 TEMP EVENT APPEHD 16-02 <br />7/28/10 <br />J^Jlce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />P Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />3One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Refrigerator <br />Ice bath and tubs <br />Extra <br />Water <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chaffing <br />Dish <br />5 Gai Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_____________________________ <br />Health Permit <br />Important** <br />i-hhkbbhbbbmshihmmhii <br />Extra Ice dags & Food Containers must be H <br />stored 6 inches off of the ground’ j <br />\0IJ1S' <br />' Title <br />u»__ <br />Signature <br />Ice Cooler ;,. 9 <br />J4—.T <br />Rinse Water <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 —— ---------33. <br />’ the Rowing 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 1 <br />tooth13^^'09 the f°llowin9 f0r adecluate hand washing facilities, but separate from utensil wash within my <br />“X .... / <br />----- !—\------------ J |C7 <br />Garbage <br />Can <br />0 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).