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10. <br />|4fA <br />11. <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />12. <br />13. <br />Important** <br />14.Completed by: <br />Date <br />Health Permit <br />Paper Hand Tenets <br />Cutting Boat'd <br />Propane Stove <br />Propane Tank <br />Breach and Water <br />X Fire ExtinguSsher <br />PageaoT 11 TEMP EVENT APP <br />I <br />EHO 16-02 <br />z/2 ano <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <br /> Refrigerator <br /> ice bath and tubs <br />5 Gai Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Exira fee Bags & Food Cofitainers. owst be <br />stared € fsc/ies otforthegmartd1. <br />Stemo w/Chaffing <br />tXsh <br />Sanitizer bucfcel- <br />Headi& water for <br />storing wiping dolhs <br />Title <br />Soap and Water <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 41T temperature): <br />-----------------------rx <br />Ice Cooler_______F <br />I Soap dispenser <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />\ Three compartment sink.OR v <br />\ solution (one tablespoon of bleach per gallon of water). <br />[3 Detergent, bleach, and wiping cloths (cleaning towels). <br />El Tub to store wiping cloths in bleach solution. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_________—X -—/-----------,___//. I , y , J_____________________ <br />_________X W //X . I /X14Z-------------------------7 <br />All fodd 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 arid operation. Return original to festival coordinator three weeks prior to <br />this event <br /> Signature^ <br />Rnso Water <br />l^am^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br /> Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q Paper towels and pump-style soap container.