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10. <br />11. <br />OR <br />12. <br />13. <br />14. <br />Health Permit <br />Paper Hand Towels <br />Bleach <br />Propane Stove <br />IO <br />Propane Tank <br />Bleach and WaterSoap and Water i/ <br />Fire Extinguisher <br />Ice Cooler Ii <br />stored 6 inches on of the ground!TEMP EVENT APP <br />Page 8 of 11 <br />EHD 16-02 <br />8/1/14 <br />Stemo w/Chaffing <br />Dish <br />5 Ga! Hand wash <br />Wastewater Container <br /> 5-20 Ga). <br />Hand wash Water <br />Garbage <br />Can <br />Ice chests <br />0 Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />E'Tce bath and tubs <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Extra ice Bags & Food Containers must be tg <br />stored 6 inches oft of the ground! <br />xzz <br />Rinse Water <br /> <br />Title <br />“Important*" <br />cleaning of food preparation utensils: <br />I am providing the following cold temperature control for the cold holding of potentially hazardous tooos below <br />45OF (if food is used the following day, maintain below 41 °F temperature). <br />I am providing the following items within my booth for the sanitary' <br />Date <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Test strips to measure sanitation levels Tor bleach solution measuring 10Oppm. <br />0 Tub to store wiping cloths in bleach solution measuring 100ppm. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />0 Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br /> All food vendor booths are subject to inspection. Please make a copy of this applicatiorin <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />0 Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one Tor a bleach <br />solution (one tablespoon of bleach per gallon or water). <br />j Soap dispenser <br />-----------------------—--------------------------s <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />preparation for this event, <br />preparation and operation. <br />this event. <br />Completed by: <br />Signature <br />Extra <br />Water