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10. <br />11. <br />OR <br />5-2-I-7 <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />12. <br />□ Water supply dispenser with warm water at a minimum of 1003F (i.e. 5-20 gallon container with spigot). <br />13. <br />••Important1 <br />Completed by: 14. <br />Signature <br />Health Permit <br />Popsr Hand To*e<» <br />Soap dispenser <br />Cutttna Board <br />BleacnPropane Stove <br />a <br />Propane Tank <br />Bleach and waler <br />Fire Extinguisherfl <br />Ice Cooler <br />TEMP EVENT APPPoqs 8 of 11EHD 16-02 <br />11/4/14 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45DF (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 ico Bags S Food Containers must be <br />stored 6 metres off of the ground1 <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 />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gai Hand wash <br />Wostawafer Container <br />Garbage <br />Can <br />Sanitizer Ouckfll- <br />bleacti & waler tor <br />stonng wipng dotr.s <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />jA Three compartment sink. <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 />Stoma w/Cnatfiog <br />Dish <br />5-20 Gal <br />Hand wash Water <br />Extra <br />Water <br />□Kce chests <br />/t] Refrigerated truck <br />□ Other (specify) <br />Da <br />— <br />Soap and water Rinse Water <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation; <br />_______________K\Cvc\Ca Lcoyck