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IMAG0i31.JPG 8/26/19, 3:31 PM <br />10. <br />11. <br />12. <br />14. <br />UJ'' <br />7Completed by:15. <br />Health Permit <br />Paper Hand Towels <br />Propane <br />Btoach and Wat«rKiftsn WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />about:blank Page 1 of 1 <br />/|m portant** <br />□ 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 items within my booth for warewashing: <br />Q'Three compartment sink. <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 />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Extra fee Sags S Food Coolaxters must be <br />stonirf 6 mcties off ot the ground' <br />PfRefrigerator <br />□ Ice bath and tubs <br />Sanitizer bucket- <br />bteach & water for <br />storing wiping cloths <br />D^e <br />Mames of respopsible persons to bet present in booth during all hours of operation: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensji <br />V <br />^ detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />A Ice chests <br />I ^Refrigerated truck <br />□ Other (specify) <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth. <br />[ZTWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). * <br />jparate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-styte soap <br />Zntainer. <br />All food vendor booths are subject to inspection. Please make a copy of this application'vn <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 />Title <br />I Propane Tat* <br />this event. / <br />(Ml <br />Signature <br />Soap dispenser <br />Stenio w/Chafling <br />Dish <br />5-20 Gal <br />Hand wash Water