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10. <br />li-rlce cnesrs <br />i am oroviainq me roiiowina nems wimm mv Doom ior warewasnma:i i <br />OR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:12. <br />I'efergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13. lam providing the following tor adequate hand washing facilities, but separate from utensil wash within my booth: <br />1-1. <br />I.kJ ci <br />15.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />□ 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 />EHD 16-02 <br />7/14/15 <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 />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal. <br />Hand wash Water <br />i i KeTnnRr^-. <br />Q'tSe’bath and tubs <br />Title <br />□ Three compartment sink. <br />l^^fftrefTdeep 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 />ll1—-ti | <br />**lmportant** <br />Date <br />Names of responsible persons to bo <br />a ac/ \ , S/M /ft <br />B-t/Vater supply dispenser with warm water at a minimum of 100°F (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 />Propane Tank <br />------------------------1 <br />J (_ JU L X J _ <br />Garbage <br />Can <br />x <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground! | <br />Tl f~~ <br />Soap and Water