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10. <br />VI am providing the following items within my booth for warewashing:11. <br />Q Three compartment sink. <br />OR <br />12. <br />13. <br />14. <br />[)Completed by:15. <br />Signature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BteacliPropane Srpve <br />71 <br />Bleach and Waler <br />Are Extinguisher <br />1<O <br />kI <br />Page 8 of 11 <br />Ice Cooler j <br />EHO 18-02 <br />7/14/15 <br />Extra Ice Bags A Food Containers must ba <br />stored 6 tncltes off of the ground! <br />□ Refrigerator <br />□ Ice bath and tubs <br />Garbage <br />Can <br />Sanitizer bucksv <br />bleach & water <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />TEMP EVENT APP <br />C-Hce chests <br />Q Refrigerated truck <br />□ Other (specify) <br />6 Gal Hand wash <br />Wastewater Container <br />Stem© w/ChafGng <br />Dish <br />Extra <br />Water <br />S-20 Ga*. <br />Hand wash Waler <br />I | Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils. <br />0 Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />WJ. <br />Title <br />Jf’T ' L.'-_ ...... <br />Soap snd Water <br />y ■ <br />it*_ l-jSSsW?' <br />| Health Permit <br />"Important*"* <br />I am pm.M.x, the following r.oM temperalure control ter the cold’ holding 0< potenHally hazardous foods below <br />45T (if food is used the following day, maintain below 41JF temperature). <br />Names of responsible persons to be present in booth during all hours of operation: <br /><Mra . ('■ /H'-i lore-kAh'-------- <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 j^yfent. <br />O%t_ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth. <br />O 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-fityle soag <br />container. <br />Propans Tant <br />.x.- - <br />.. ...y. :^...-A.c.:: \ <br />Rinse Water <br />for rinsing and one for a bleach