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14. Completed by: <br />Title <br />Health Permit i Paper Hand Toweia <br />I Soap dUpensasr I ..........— <br />BleachfMpana SWv« <br />it <br />Propww Tank <br />Fwe Ex»n©ulstw <br />TEMP EVENT AFP <br />Scop and Water <br />EHD 1642 <br />07/28/ie <br />Stemo ^/Chaffin® <br />Ossh <br />5-20 Gat. <br />Hand «vash Water <br />SGalHondwMh <br />WaOtwMM* Ccntoirter <br />Sorutizoe hvckot- <br />btoachawwrfor <br />storint) wlpit'iQ cloiita <br />Date <br />**Important** All food vendor booths are subject to inspection. Please make a copy of this application <br />in 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 <br />to this events'Sj&L <br />~' Signature <br />Gartoa®e <br />Can <br />10.1 am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45 degrees Fahrenheit (if food is used the following day, maintain below 41 degrees Fahrenheit): <br />Ice chests K Refrigerator [ ] Refrigerated truck <br />[ ] Ice bath and tubs [ ] Other (specify): . ---------------------------- <br />11.1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />[ ] Three compartment sink <br />°R <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 cloths (cleaning towels). <br />pl Tub to store wiping cloths in bleach solution. <br />12.1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 100 degrees Fahrenheit (i.e. 5-20 gallon <br />container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. Name^^^^ansi^ p^^m^be present in booth during all hours of operation: <br />Lt__ <br />I Extra \ <br />I Water I <br />Ice Cooler <br />5/ 1 Ban taa Baa* t Food ConttUonmnitb* ■ <br />-------- —.....------x I storadOiaohoaoBotaagroundl I.! <br />— —. <br />Boolh must te on <br />Concrete. Aaphatt, <br />Plywood, or a Tarp. <br />k _____ <br />| CuUngScsrd