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10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />OR <br />J^Detergent, bleach, and wiping cloths (cleaning towels). <br />12. <br />Shaper towels and pump-style soap container. <br />Names.of responsibh13. <br />uCompleted by: 14. <br />Date <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguishera <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />Soap and Water Rinse Water <br />"^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />'®Dne separate tub (bucket or basin) for the collection of rinse/wastewater. <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 />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />If' - ' . <br />^J^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 /> Three compartment sink. <br />Efrhree 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 />^4 Ice chests <br /> Refrigerated truck <br /> Other (specify)J <br />5-20 Gal. <br />Hand wash Water <br /> Refrigerator <br />; Ice bath and tubs <br />/Signature <br />Title <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 />4h is pvent. / ) <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />I <br />Propane Tank <br />-------------------------i <br />**lmportant** <br />> of responsibleoersons to be present in booth during all hours of operation: <br />F Health Permit