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10.I <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />[J Three compartment sink. <br />OR <br />12. <br />d Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Q One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />Completed by:14. <br />TitleSignature <br />4 <br />Paper Hand Towels <br />Cutting Board <br />BleachPropane Slovs <br />n <br />Bleach and Water <br />Fire Extinguisher <br />ooler 'Ice <br />stored 6 inches off of the ground! <br />TEwiP EVENT APPPage 8 of 11)2 <br />LZ <br />Rinse Water <br />EHD 16- <br />8/1/14 <br />.’iS'lce chests <br />[J Refrigerated truck <br />P Other (specify)__ <br />!3 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 />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 />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />yS Detergent, bleach, and wiping cloths (cleaning tow/els). <br />|j J Test strips to measure sanitation levels for bleach solution measuring 10Oppm. <br />[J Tub to store wiping cloths in bleach solution measuring 100ppm. <br />0, Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />---- <br />He alth Permit <br />I <br />Date <br />-Important** <br />Soap and Watsr <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />----------------.----------------... <br />Extra ice Bags & Food Containers must be <br />Names of responsible persons to be present in booth during all hours of operation: <br />Garbage <br />Can <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 operatiopzTtetum original to festival coordinator three weeks prior to <br />this event. , // <br />j Propane rank <br />Soap dispenser