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theupsstore No. 2854 P, 29 02/02 <br />10. <br />‘ OR <br />for soapy water, one for rinsing gnd one for a bleach <br />12. <br />13.•nssant In booth during a[J hours of operation.1 <br />“Irnportapt** <br />14.Completed by; <br />Title <br />Health Permit <br />6bh <br />Paper k^ndToweteI Soap cfap^nxr <br />TEMP EVENT APP <br />4. 2016 12:50PM No. 0539 <br />Extra <br />Water <br />SertPzfirbudicU ’ <br />btedch &. wf ttf (t>f siwina wiping cloths <br />EHD 16.0? <br />11/4/1x1 <br />□ Refrigerator <br />□ Ice bath and tubs <br />6<2O Gil. <br />w©sn vveler <br />Garbage <br />Can <br />Booth mi/Bt be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp, <br />Received Time Mar. <br />’"Mar. 4. 2016a12:59PM2098GHI RARDELL I <br />W«»le»vA!w GonisVier <br />Pags 8 of n <br />5t*mo WCMfinn I___F h <br />' wSb.i~ <br />O (ce chests <br />d Refrigerated truck <br />□ Other (specify). <br />5oas> find W^\<f <br />FKe Extingu[»b<r | <br /> <br />Proptma TsnK <br />| Cultln^Bo^rQ <br />Propane Slave . <br />Date <br />Blnse Water BJeeoh »nd Visf.ar <br />rCZZTTZT’ <br />Ice Cooter I 1 <br />. i1's«irj Bess X FwdContairHi’nmudbe H <br />Mwtr e ii^hn o.t ot in» smindi ’ <br />n. lam providing lha follOTi„B Items within my booth for the sehtery dearang tf feed preparation uronste <br />□ Three compartment sink. <br />□ Tnree deep tubs (basins 6-8 inches minimum), one <br />solution (one fablespoon of bleach per gallon of water). <br />O Detergent, bleach, snd wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels forbleach solution measuring 100ppm. <br />□ ub to store wiping cloths in bleach solution measuring WOppm. <br />‘ ^P^dlng the following for adequate hand washing Mies, but separate from utensil wash within my' <br />gWater supply dispenser with warm wgfer at a minimum of 10D'F (i.e. 5-20 gallon container with spigot), <br />^Une SQpara(e lub (bucket or basin) for the collection of rlnse/wastewater. <br />I^Papar towels and pump-style soap container <br /><^re Sponsj^le^er^ns t^be^i <br /> <br /> -preDamifon'for *a^1 tolr’5Psc'iotl- ple^ make a copy oTfhfe appttcaf^Tm <br />hfZk S f rJh,ls evenL A c°py of this Checklist must ba in the booth at all hours of <br /> and Operat'0ri- -Raturn prjqjpal to festival coordinator three weeks prior to <br /> <br />' Signature