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Mar. 30. 2018 8:45AM No. 4977 P. 5 <br />10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />OR <br />El Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />KJ Paper towels and pump-style soap container. <br />13. <br />**lmportant** <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels <br />Soep dispenser <br />C<nang Board <br />BieacnPropane Slow <br />Propane Tank <br />Soup end Weler Bleach and Waler <br />Fire Extinguisher <br />TEMP EVENT APP <br /> fe—.JS'VTT~ <br />NaTnes of responsible persons to be present in booth during all hours of operation: <br />Randy Whetstone , Adaire Whetstone <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />Slerrwj w/Chaft’mg <br />■ Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Oal Hand wash <br />Waslewaler Coni skier <br />Garbage <br />Can <br />Saritizer bucket­ <br />bleach i. waler for <br />sloring wiping do'-hs <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />El Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />6JO Gal. <br />Hand wash Waler <br />[ Exva \ <br />I Water <br />Title <br />L <br />Rinse Waler <br />---------4Ice Cooler <br />___________/ <br />Date <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 />J Signature <br />EXlrsi Ice Bs>gs & Pood Containers must be B <br />stored 6 inctns offo/lho ground! ffl <br />Received Time Mar. 30. 20 1 8 8:39AM No. 32 7 7 Paaeso/n <br />7/28/10