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10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />OCThree compartment sink. <br />OR <br />Q Detergent, bleach, and wiping cloths (cleaning towels). <br />Gl Test strips to measure sanitation levels for bleach solution measuring 100ppm <br />EJ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />12. <br />[3. 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 rinse/wastewater. <br />EK Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Z <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Page 8 of 11 TEMP EVENT APPEHD 16-02 <br />11/4/14 <br />0 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 />Names of responsible persons to be present in booth during all hours of operation: <br />________/\i< ,-'r dLc iri'/i ,________________ <br />EJ Ice chests <br />[3 Refrigerated truck <br />□ Other (specify) <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 />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 />Stemo w/Chaffing <br />Dish <br />EEL Refrigerator <br />0 Ice bath and tubs <br />5 Gal Hand wash <br />Wastewaler Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water (or <br />stonng wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />5-20 Gal <br />Hand wash Water <br />J <br />Soap and Water Rinse Water <br />Ice Cooler <br />Extra /ce Bags & Food Containers must be E <br />stored 6 inches off of the ground1 <br />| Health Permit <br />‘‘Important** <br />Tifie /0te <br />Extra <br />Water