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10: <br />[ am providing lhe following items within my booth for rhe sanitary cleaning of food preparation utensils:11 <br />OR <br />♦Bf Detergent, bleach, anc wiping cloths (cleaning towels) <br />12. <br />4BT Water supply dispenser with warm water at a minimum of 100”F (i.e. 5-2C gallon container with spigot). <br />-P^t One separate tub (bucket or basin) for the collection o: nnse/wastewater <br />S'Paper towels and pump-style soap container <br />13. <br />•’Important'* <br />Completed by: 14. <br />Signature <br />Paper Hand Towels <br />Soaj dsperser <br />CuttiAQ Bcn.-d <br />Bieac.'iProoace Slc-e <br />0ifDit <br />Btoacli an i WaterRmse Water <br />Fite Extnpwsner <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />__J <br />Soap a M Water <br />EHD 15-02 <br />7«ano <br />Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gai wash <br />Was! ewale' Contar<ar <br />Sanitizer bu^et- <br />aeaob & waierler <br />storing wipinoclcths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches m nimum). one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />£>B9 icsB^gs 6, food Ccn.'^mets fnust be <br />siorad 5 incbesbfJ of *ho <br />rXfa <br />waier <br />5-20 Grf. <br />Hand wash Watw <br />Stoma w-Ctiaffing <br />Dish <br />Garbage <br />Can <br />1 <br />IT <br />Names of responsible persons to be present in booth during all hours of operation: <br />------------------------------------------------ ------- <br />Title <br />Health Permit f- <br />■fiT Tub Id store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />to-CX-', <br />Date <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 foliowing day, maintain below 41 °F temperature): <br />All food vendor booths are subject to inspect on. Please make a copy ol 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 />: P-opane Tenk