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10. <br />11. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />13.Nai <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />JCutb'og Board <br />Propane Stova Bleach <br />Bleach and Water <br />Page 8 of 11 TEMP EVENT APPEHD 18-O2 <br />7/28/10 <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />StemovtfCbaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer budket- <br />bteachA waler for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gat <br />Hand wash Water <br />Extra <br />Water <br />Title <br />I <br />Soap and Water <br />=?= <br />Rinse Water <br />“Important** <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />PSyThree 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 />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 />thfeeVent. <br />ipas^of responsible persons to be present in booth during all hours of operation: <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^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Sf Paper towels and pump-style soap container <br />booth-PrOVidin9 the f°,i0WiR9 for adeciuate hand washing facilities, but separate from utensil wash within my <br />Soap dispenser <br />Exira/ce Bags & Food Containers must be I <br />stored 6 inches erf of the ground! ffl <br />____| Fire Exlingustier <br />irT <br />Ice Cooler [i <br />| Propane TanK