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10. <br />11,I am providing the following items within my booth for warewashing: <br />O Three compartment sink. <br />OR <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />[3 Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />"Important” <br />15.Completed by: <br />Date <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />it <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />7/14/15 <br />3 Water supply dispenser with warm water at a minimum of lOCTF (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />□ 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 />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <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 following day, maintain below 41 “F temperature): <br />[X] Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastawatef Container <br />Names of responsible persons to be present in booth during all hours of operation: <br />Ken Albala <br />Sterno w/Chaffing <br />Dish <br />5-20 Gel. <br />Hand wash Water <br />Samtiser bucket- <br />bleach & water for . <br />storing wiping cloths <br />‘ Ice Cooler <br />£ <br />Soap and Water <br />/ <br />Rinse Water <br />J <br />Extra ice Sags 4 Food Ccniein^r& mu^i ba 2 <br />stored 6 Inches off of the ground! <br />,4^7 <br />Health Permit <br />■ <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 operation. Return original to festival coordinator three weeks prior to <br />_C. <br />Signature Title Date <br />c -h Booth must be on <br />/ Concrete. Asphalt, <br />- Plywood, or a Tarp. <br />Extra <br />Walw