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10. <br />11. <br />OR <br />12. <br />13. <br />'Important*1 <br />Completed by: 14. <br />Health Permit <br />1 Paper 1-taod Tcwefc <br />J1 <br />Cuttog BaarC <br />Pnspano Sfow <br />] [&eoch otxJY/alcr <br />Fire Exftigtisfter <br />Page 8 or 11 TEMP EVENT APP <br />l' • •• . _/ I . <br />EHD 1G-02 <br />7/2B710 <br />Stemo w/Cbaffing <br />Dish <br />Saritizcr bucjcet- <br />blcach & waler for <br />siortno wiping dolhs <br />Extra <br />Water <br />S Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />5-20 Gal. <br />Hand wash Waler <br />fee Baas i Food ContairKrs enust b& <br />d C inches off of Bio grwnd! <br />f~ <br />Rihsa Water <br />Water supply dispenser with warm water at a minimum of 10O’F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinseAvastewater. <br />^K^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during ail hours of operation: <br />| Exira! <br />I stored \ <br />Soap □nd '.Viter Garbage <br />Can <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />^^Three compartment sink. <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 of bleach per gallon of water). <br />^^Detergent, bleach, and wiping doths (cleaning toweis). <br />^^Tub to store wiping cloths in bleach solution. <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 Title <br />Ice Cooler fe <br />I Propane Tank <br />Jj <br />Mijk [Sj <br />1 ax«£r?yLciin?.fhe fol!owin9 temperature control for the cold holding of potentially hazardous foods below <br />45 F (if food is used the following dey, maintain below41 °F temperature): <br />Soap dispenser <br />l am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: <br /> ice chests ^Refrigerator <br />Refrigerated truck ice bath and tubs <br />XI Other (specify) ~ iGOAVyT Sop-V S>Q-T< Q_ \PT\ <br />□ate