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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 />Ol <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 />Completed by: 14. <br />Signature <br />]Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cuttina Board <br />BlsactiPropane Sieve <br />Bleacn and Aaiw <br />Fire ExtinpusherQ <br />Ice Cooler <br />TEMP EVENT APPPaQe 0 ot 11EHO 16-02 <br />11/4/14 <br />B’lce 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra lea Bags i Food Containers must be <br />stored 6 inches od of tbe ground1 <br />Sterr« wfCnaMng <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gai <br />Hand wasn Water <br />Garbage <br />Can <br /> Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <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 />Sanitizer becket <br />bleacn & water for <br />stonng wipng ctctns <br />Extra <br />Water <br />Da <br />Names of responsible persons to be present in booth during all hours of operation: <br /> aj'niS.---------------------------------------------- <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 />Prcoane Tank <br />------------------—J <br />Soap and Waar Rinse Water