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10.I <br />I am providing the following items v?ithin my booth for the sanitary cleaning of food preparation utensils:11. <br />[J Three compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />12. <br />jStPaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation:13. <br />Completed by:14. <br />Title <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />! ice Cooler ; <br />TEMP EVENT APPPage 8 of 11)2 <br />£_ <br />Rinse Water <br />EHD 16- <br />8/1/14 <br />[J 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 />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />[0 Ice chests <br />□ Refrigerated truck <br />[J Other (specify)__ <br />iI <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />'^Refrigerator <br />□ Ice bath and tubs <br />^X^est strips to measure sanitation levels for bleach solution measuring lOOppm. <br />Q Tub to store wiping cloths in bleach solution measuring 100ppm. <br />Extra tee Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />6/3^/^ <br />Date <br />Soap and Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />^l^/ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />‘‘O One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />: . ........- _ <br />^important** 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, /] <br />— - -- <br />-------------------- <br />_—-------------------- <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />J Propane Tank <br />I Soap dispenser