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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 />□ Three compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <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 />□ Paper towels and pump-style soap container. <br />13. <br />Important** <br />14.Completed by. <br />DateSignature <br />Health Permit <br />Paper Hand Towali <br />Scap diipenwr <br />ProptM-e Stove <br />Propane Tank <br />Beacr. and Waler <br />Frt ExoncutherG <br />Ice Cooler <br />TEMP EVENT APRPaga 8 of 11 <br />i <br />EHD 10-02 <br />11/4/14 <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 />□ 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 />Sleroo w/Cnafflng <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 QN Htnd W«>n <br />Wajlowtwr CorUmor <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer Ducket <br />Waach 5 wator lor <br />stcnng wiping aorrs <br /> Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Title <br />Er.fa 'co ftegr S Food Conttmecs mjV Sa H <br />stored J mcnej of toe ■ <br />Names of responsible persons to be present in booth during all hours of operation: <br /> Tfl food vendor booths are subject^ 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 />Soap «nd W«t«r R. m Wmf <br />| Cutting Board | <br />ExVa <br />W«sr