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10. <br />11. <br />OR <br />for soapy water, one for rinsing and one for a bleach <br />12. <br />my <br />of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />14.Completed by: <br />£Sfgnature <br />Health Permit <br />~1 Paper Hand Tcwefs <br />JPropane Stove Bleach <br />Bleach and Water <br />Page 8 of 11 <br /> <br />TEMP EVENT APP <br />EHD 16-02 <br />7/28/10 <br /> <br />5 Gal Ha nd wash <br />Wastewater Container <br />Garbage <br />Can <br />Saritizerixjcfcet- <br />bleachS water (or <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stemow/Chaffing <br />Osh <br />/ Extra \ <br />I Water <br />ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I Fire Extinguisher <br />Date <br />5-20 Gal. <br />Hand wash Waler <br />□ Refrigerator <br />^Ice bath and tubs <br />i- <br />ice Cooler | <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 <br />■solution (one tablespoon of bleach per gallon of water). <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />’QTub to store wiping cloths in bleach solution. <br />Soap dispenser <br />I Propane Tank <br />Soap and Water <br />I Exira Ice Bags & Food Containers nwsl be ■ <br />stored 6 inches off of the ground! <br />.zy <br />Title (J <br />___ <br />Kevent1 a"*3 °PeratlOn' Return ork»nal to festival coordinator three weeks prior to <br />Nm providing the following for adequate hand washing facilities, but separate from utensil wash within <br />zfe 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 rinsefwastewater. <br />Q Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Z-S)| ivo/A jV Utt -------------- <br />Cutting Boerd I <br />II <br />Rinse Waler