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10. <br /> <br />11. <br />OR <br />12. <br />5 <br />14. Completed by: <br />Health Permit <br />Paper Hand Towtfs <br />CutUng BoanJ <br />Propan® Stove <br />Ffre ExUngusher | <br />Page 8 or 11 TEMP EVEMT APP <br />EHD 164)2 <br />7I23H0 <br />SGalHaidwash <br />Wssrcwaler Container <br />SSO Gal <br />Hand vrasn Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, oraTatp. <br />□ ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />□ Ice bath and tubs <br />Sarrtizdr bucfret- <br />Heach & yyaterlor <br />siortng wiping dfoths- <br />Extra <br />Water <br /> <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />StemavrfChaftiflg <br />Dish <br />□ Water supply dispenser with warm water at a minimum of 100T (l.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for foe collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />| Bleach <br />Quu <br />Title <br />I <br />Soap and Water <br />l^am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />----------------Ice Cooter | j <br />[ Propane Taft > <br />□ Three deep fobs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />sol ution (one tablespoon of bleach per gallon of water). y cn <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />C -~3c>—ly. <br />Date <br />I Soap dispenser I <br />1 <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 />Signature <br />13- ^S^^b0°tll^^ng 311 hQLIrS °J °PeJ^^ri: <br />"Important** <br />| Breach anJWafef ) <br />Exira Ice Sags & Food Confahers owsl be H <br />stored 6 focnescrr or the ground! p <br />XFxr^jji <br />RTnsa Water