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10. <br />11. <br />OR <br />12. <br />13. <br />this event <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Pre cane Stove Bleach <br />Prepare Tank <br />Soap and Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />stor&d V inches off o'the ground! <br />Pr ge 8 of I • <br />fEMF t’/PFF API- <br />Rinse Water <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Extra <br />Water <br />□ Refrigerator <br />□ Ice bath and tubs <br />Cani'izer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal. <br />Hand wash Waler <br />£HD ; 6-0.2 <br />' Ti ■. 0 <br />□ Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />EJ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />bi <br />Extra Ice Bags ft Fcori Cor.tr,:'-iars rr.jst De| { <br />" ; _7 i <br />Health Permit <br />rule <br />--------- <br />Garbage <br />Can <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />**lmportant** <br />Booth must be on I <br />Concrete, Asphalt, I <br />Plywood, ora Tarp. <br />1 ?in^ •‘he foflT'Hp C0'd temPerature control for the cold holding of potentially hazardous foods below <br />45 F (if food is used the following day, maintain below 41T temperature): nazaroous roods below <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />^™hProviding the following for adequate hand washing facilities, but separate from utensil wash within my <br />a copy of this application in <br />. . •' — ----------- - ...ww* ni the booth at all hours of <br />3nd operatlon- fteturn original to festival coordinator three weeks prior to <br />/'s <br />“signattfre Title bate / <br />Names of responsible persons to be present in booth during all hours of operation- <br />' - \U\Uu Gi/g) <br />All food vendor booths are subject to inspection. Please make a <br />preparation for this event. A copy of this checklist must be in <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). y h <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution.