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10. <br /> <br />11. lam providing ths following items within <br />OR <br />12 <br />’aper towels and pump-style soap container. <br />13. <br />’‘Important** <br />Title Date <br />14.Completed byr <br />^SlgnSfui <br />Health Permit <br />PcjM/HartdTwefs <br />Soaptfspeqser <br />Propane Stove <br />2I Pnjpaxw Tank <br />fee Cooter <br />Pages of 11 TEMP EVCMTAPP <br />EHD 16412 <br />7/2B/10 <br /> Ice chests <br /> Refrigerated truck <br />0 Other (specify) <br />Water supply dispenser with warm water at a minimum of 10OT (i.e. 5-20 gallon container with spigot). <br />Qne separate tub (bucket or basin) for the collection of rinseAvastewater. <br />Stemo wfCbatfing <br />Dish <br />5-20 Gal <br />Hand wish waier <br />Garbage <br />Can <br />S Gal Karri wash <br />Wastewalcr Cortatoar <br />Saritizerbuffceb <br />b-'each^ water iw <br />storing vpp? ng do Ihs <br />Inspection' Please <br />>f this checklist must be in the booth at all hours <br />Soap and WaTcr Breach srt Ytetac | <br />[ Bleach <br />I <br />If1is ' <br />Name^ of responsible perspy s to be present in booth during all hours of operation: <br /> <br />preparation for this event. A copyXf this checklist must be in the booth at all hours of <br />preparation and operation. ^Return original to festival coordinator three weelre prior to <br />this event. -“---------------------- <br />Boolh must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. ___;__ _ j <br />Bags & Pars ■ <br />jlareUOAxOesoirorWograwill ■ <br />Culling Board <br /> Three compartment sink. <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for nosing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />^^Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />3Qz3i <br />Rinse Witter 1 I" <br />( EMra \ <br />Wslsr <br />FtreExSngu'rfw I <br />bwth-pr0Vid'n^ fo,Iowin9 f°r aciecluaie hana washing facilities, but separate from utensil wash within my <br />1 Piding the following cold temperature control for the cold holding of potentially hazardous foods below <br />45 F 0f food is used the following day, maintain below 41°F temperature): <br />^B^Refrigerator <br />i Ice bath and tubs <br />______________________ <br />m/booth for the sanitary cleaning of food preparation utensils: