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P. 5No. 4823Sep. 28. 2017 9:5 1 AM <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br /> Three compartment sink. <br />OR <br />13. <br />‘‘Important** <br />(WGTitle <br />Completed by:14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />OjtBna Board <br />Propane Slove <br />Propane T ank <br />Efleixzi and WalerRinse waterSoap and Waler- <br />Fire extinguisher <br />TEMP EVENT APRPage 8 of 11 <br />Slornow/Ciwlfing <br />ofcn <br /> Refrigerator <br /> Ice bath and tubs <br />5 Gal Hand wash <br />was! wal er Conlalne r <br />Carnage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Received Time Sep. 28. 2017 9:50AM No. 2372 <br />7/28/10 <br />EJ Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />Extra <br />Waler <br />&.2O Gel. <br />Hand wash Waler <br />Sanitizer buckel- <br />blaaeh & waler (or <br />storing Wiping ctolhe <br />Names of responsible persons to be present in booth during all hours of operation: <br />Randy Whetstone , Adaire Whetstone ____________ <br />Ice Cooler -J <br />__________/l<x £ij>9s i Food Ccmlslners musl be M <br />stofsd 6/nates off of the grwndl "U <br />Date <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Tj- Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />o One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />KJ Paper towels and pump-style soap container. <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 />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. t \ <br />11- r <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />ioliition (one tablespoon of bleach per gallon of water). <br />(3 Detergent, bleach, and wiping cloths (cleaning towels). <br />12. <br />Soap dispenser <br />Bleach