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P. 5Apr. 1 9. 20 1 7 8:37AM No. 4644 <br />10. <br />11.providing (he following items within my booth for the sanitary cleaning of food preparation utensils: <br />rhree compartment sink. <br />OR <br />S Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />ECI Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />Completed by:14. <br />Paper Hand Tovels <br />Soap dispenser <br />CulSnp Board <br />Propane Stove <br />Soap and Watev Rinse Water Blench and Woter <br />z.Hre Extinguisher <br />Pago 8 of 11 TEMP EVENTAPP <br />B <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 />EJ 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 />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 />□ Refrigerator <br />□ Ice bath and tubs <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Randy Whetstone , Adaire Whetstone <br />Slsmo w/Cfis!fing <br />Dish <br />Water <br />5 G=1 Hand wash <br />WasKrwater Contateer <br />SsnMsw bucket- <br />bleach & waler for <br />sieving wiping Oolhs <br />5-20 Gal. <br />Hand wash Water <br />Title <br />EHD 16-02 <br />Received Time Apr. 19. 2017 8:36AM No. 1277 <br />I Health Permit p <br />Date <br />I Propane Tank <br />Exl'elceeoQS&FooaOjnlBlnersmunbe H <br />slated 6 Inches off of the QrModl Ifl <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth; wur-d s <br />□ Water supply dispenser with warm water at a minimum of 100DF (i.e. 5-20 gallon container with spigot). <br />Ice Cooler j