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I am providing the following items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:12. <br />i am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth:13. <br />14. <br />’ Signature <br />15.Completed by:X <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board 1 BleachPropane Stove <br />Propane Tank <br />Bleach and WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />z <br />Rinse Water <br />EHD 16-02 <br />7/14/15 <br />□ Ice 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 <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />^Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />Tlbifr ________ ________________ __ <br />J <br />■ .. ? '■_______■ J <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Health Permit <br />Cs'lCsVr <br />CzODfA i Afi/Apr <br />Title <br />Detergent, bieach, wiping cloths (cleaning toweis), and a tub to store wiping cloths in bleach solution. <br />s_h^ <br />Date* <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 />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />P^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 />“Important** <br />--- <br />Garbage <br />Can