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10. <br />11. <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 lOOppm. <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 />1 Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />Propane Stove <br />Fire ExOngusnorG <br />Ice Cooler <br />TEMP EVENT APRPage 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 />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 />ExCT Ice Bags i Food Containers must be <br />stored S inches off d the ground' <br />Stemo w/Cnafflng <br />Osh <br />□ Refrigerator <br />□ Ice bath and tubs <br />Garbage <br />Can <br />Sam tiz er txicket- <br />biesen & wntor tor <br />stonng wiping doths <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 />^zfThree 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 />5 Gal Hand wash <br />Wastewalar Container <br />Names of responsible persons to be present in booth during all hours of operation: <br />_________________V-KQYxj \ ____________________________________ <br />I Extra \ <br />Water | <br />Da <br />I Prepane Tank —=r <br />Soap and Water Rinse Watar <br />O Ice chests <br />J/f Refrigerated truck <br />□ Other (specify) <br />TiBe <br />5-20 Gai <br />Hand wash Water <br />I Bleach <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 /—\