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10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />C3 Three compartment sink. <br />OR <br />[3 Detergent, bleach, and wiping cloths (cleaning towels). <br />(3 Tub to store wiping cloths in bleach solution. <br />12. <br />S Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[3 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />Title 7 Date / / <br />Completed by:14. <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cuttinq Board <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APPEHD 16-02 <br />08/01/16 <br />□ Ice chests <br />B Refrigerated truck <br />□ Other (specify) <br />S 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />Sterno w/Chaffmg <br />Dish <br />I <br />Soap and Water Rinse 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 />this event. <br />Extra Ice Bags & Food Containers must be N <br />stored 6 inches off of the ground! <br />| Health Permit |5-20 Gal. <br />r- Hand wash Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />Ri h A S _______________________________ <br />**lmportant