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10. <br />I am providing the following items within my booth for warewashing.11. <br />OR <br />12. <br />13 <br />14 <br />’"'Important''' <br />15.Completed by. <br />Title <br />I Health Permit ■ <br />7 Paper Hand Towels <br />Soap Uspensei <br />Cutting Boa-0 <br />BleachPropane Stove <br />u <br />5 Soap a <br />/>?*' P'i* Eirttriguisnei <br />Ljl <br />Bleach ano Water <br />Page 8 of 1 I TEMP EVENT APP <br />Ice Cooler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />[^Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <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 41OF temperature): <br />Starno w/ChaWng <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Exira <br />Walo- <br />5 Gai Hand wash <br />Wastewaler Conlamer <br />Garbage <br />Can <br />Samtaor sucfcel- <br />bleach 4 water •or <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />EHD 16-02 <br />7/14/15 <br />,ce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />f^, Water supply dispenser with warm water at a minimum of 100°F (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 />Rinse Water <br />77 <br />Soap and Water J <br />Date <br />□ Three compartment sink. <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 />Namesjfjg^onsible ^sor^Io^gesent in booth during all hours of operation: <br />5-2C Gat <br />r- Hand wash Water <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 />this event <br /> <br />Signature kJ <br />Propane T ank4 <br />Exfra /ce Hags .5 Food Con/ainers inus/ de K <br />stored 6 w/ies aff at the gnunai ■