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IU <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils11. <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 100T (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 />qCompleted by. 14. <br />Signature <br />p <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Q-l-l Soap and Water <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />11/4/14 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno 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. Asphal' <br />Plywood, or a Tag <br />5-20 Gal <br />Hand wash Water <br />Ice Cooler_____L/ <br />Names of responsible persons to be present in booth during all hours of operation: <br />^>CjCYV.. <br />2.GIIT <br />Date <br />□/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 />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—X <br />Extra ice Bags i Food Containers must be Bg <br />stored 5 inches off of the ground! H <br />Health Permit <br />I QI I I plOVIUHiy II IQ QKJIU IQI I ipvl caluii JOtlLlW) ijl Ll iL CUIU I IVIUH Wl . iUIa-JL J’L JL is. - <br />45°F (if food is used the following day, maintain below 41 ’F temperature): <br />[Zflce chests <br />jZ^Refrigerated truck <br /> Other (specify)