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10. <br />11. <br />Q Three compartment sink. <br />OR <br />□ Detergent, bteach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping doths in bleach solution. <br />12. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-styte soap container. <br />13.Names of <br />i-7Completed by:14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BteachPropane Stove <br />Propane Tank <br />Bteach and WaterRinse WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />Extra <br />Water <br />EHD 02 <br />08/01/16 <br />I am providing the fotiowing 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 />Sterno w/Chaffing <br />Dish <br />feLBeffigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am prcw <br />booth: <br />Extra Ice Bags & Food Containers roust be <br />stored 6 inches off of the ground! <br />r <br />Sanitizer bucket* <br />bteach & water far <br />storing wiping doths <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <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 cf bleach per gallon of water). <br />A- <br />i A <br />ividin^ (tj^^gwing for adequate hand w^hing facilities, but separate from utens# wash within my <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gakm container with spigot). <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />_____________z <br />All rood 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 ail hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this< <br />'—I <br />Garbage <br />Can <br />Tide Date