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■ <br />10.9 <br />s <br />11.I am providing the following items within my booth for warewashing: <br />O Three compartment sink. <br />OR <br />12.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />EH Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />14. <br />Completed by:15. <br />iHealth Permit <br />Pa par Hand Towels <br />Soap dispenser <br />Cultiny Board <br />B tea chPropann Stove <br />■I <br />I'ropono I rink <br />Bleach and WaterSoap and Water <br />I ire EMlnpoislw <br />i <br />I <br />TSMP EVENT APP <br />Sterna w/Chaffing <br />Dish <br />5 Gal Kane wash <br />VVHskta ate# Ceca; rsr <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I Illi in ir,' <br />r/H/lh <br />Q Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />EH Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket- <br />bleach 4 water for <br />storing wiping cloths <br />i <br />/ Ext-a <br />Water <br />Rinse Water <br />Title <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 />thia^evgnt.-, <br />AteAZ— <br />/ Signature <br />n <br />o <br />am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />EH Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />"Important** <br />Names of responsible persons to be present in booth during all hours of operation: <br />n,>. m c/rS <br />.^7 <br />■ ■ '■ <br />! I <br />Ico Cooler <br />I a h <> fljiy y ,< HKiti *’P 1(1 <br />rt #hVfw.v yvviak!/ R] <br />' ^.Fr?.ViC*in9 ,^e following cold temperature control for the cold holding of potentially hazardous foods below <br />c r (if food is used the following day, maintain below 41“F temperature): <br />VVO' V <br />EH 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).