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10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Signature Title Date <br />Dish <br />| Soap dispenser | ____Paper Hand Tew -fc <br />3.BIcacTi <br />Bleach arxmatBC <br />Pago a of ii <br />TEMP EVENT APR <br /> <br /> <br />EUD 16-02 <br />7/2BZ10 <br />5-20 Gal. <br />Hand wash Waler <br />Garbage <br />Can <br />Sarfifaerbucftei- <br />blcach-& waler for <br />storing wiping doihs <br />| I Soap and Waler <br />I Fire Extingusher 1 <br />Stemow/Cbaffing I <br />Dish <br />[ Cuttfog Board I <br />Propane Stcrva <br />( Extra \ <br />Waler <br />I 6 Gal Hand wash I. <br />Wastowalcr Container <br />45T(iffoodhazardous foods be]ow <br /> ice chests □Refrigerator <br />gRemgerated truck Ice bath and tubs <br />U Other (specify) <br />J <br />Rinsa Water <br />lam providing ihe follo»^item5wffin „y b001h tothss„,!a,aMningo,foMpreparata <br />P'Three compartment sink. <br />solution (one tabfespow of bleaciS^^^^^ S°aW Water’ One for rfnsIn9 and on® for a bleach <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />> Riding th. M|p^ <br />□ One separate tub (bucket or basin) for the collection of rinsetoastewater. <br />g Paper towels and aump-sMesoap container. <br /> <br />“Important*" <br />| Health Permit <br />PrepaSto”ior'ih"“t.’n? TSy ^"ffScMsTmua te'3 m'V,hiS a»llcalta " <br />I P.-opaneTarft j £ ~ <br /> lip/ <br />ice Cooler JsJ <br />=?} Booih muss be on <br />‘ L Concrete, Asphalt, <br />Plywood, or a Tarp,