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I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />iree compartment sink. <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 />'aper towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by: 14. <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11 <br />^1 zuilT <br />Da e <br />EHD 16-02 <br />11/4/14 <br />Ice chests <br />^Refrigerated truck <br />□ Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <br /> Booth must be or <br />Concrete, Asphall <br />Plywood, or a Taq <br />5-20 Gal <br />Hand wash Water <br />Ice Cooler <br />‘z <br />I <Jlll »IMII I J Ml- I . II I .f- ^l vXVuil . — . . - <br />45’F (if food is used the following day, maintain below 41°F temperature): <br />L <br />Soap and Water <br />z_ <br />Rinse Water <br />0 <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. /—x <br />Extra /ce Bags & Food Containers must be 14 <br />stored 6 inches off of the ground1 8,3 <br />| Health Permit <br />Propane Tank <br />°R / <br />ZX ' ( D Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />\ C—(V '' \ solution (one tablespoon of bleach per gallon of water). <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />Names of responsible persons to be present in booth during all hours of operation: <br />____________"QCaVX(\i\ Q V\Q\ GY \_________________________