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15. Completed by: <br />| Health Permit <br />Paper Hand Towels <br />Ice Cooler I Wastewater Container <br />TEMP EVENT APP <br />Page 6 of 6 <br />EHD 16-02 <br />07/14/15 <br />Extra tee Baffs A Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/Ch affinp <br />Dish <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Date <br />5*20 Gal. <br />Hand wash Water <br />Signature <br />Propane Tank <br />0 <br />**Important** <br />I Cutting Board <br />Propone Stove <br />Title <br />All food vendor booths are subject to inspection. Please make a copy of this application <br />in 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 Parade Manager three weeks prior to <br />this event. <br />.10.. I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45 degrees Fahrenheit (if food is used the following day, maintain below 41 degrees Fahrenheit): <br />p] Ice chests [ ] Refrigerator [ ] Refrigerated truck <br />[vflce bath and tubs [ ] Other (specify):___________________________________ <br />11.1 am providing the following items within my booth for warewashing: <br />[ ] Three compartment sink <br />OR <br />[vzj^fhree 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 />[■vJDetergent, bleach, and wiping cloths (cleaning towels). <br />[vf'Tub to store wiping cloths in bleach solution. <br />12.1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />[^Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13.1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />['Y Water supply dispenser with warm water at a minimum of 100 degrees Fahrenheit (i.e. 5-20 gallon <br />container with spigot). A separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels <br />and a pump-style soap container. <br />14. Names of responsible persons to be present in booth during all hours of operation: <br />A •_______________ <br />Garbage <br />Can <br />Bleach and Waler <br />Fire Extinguisher <br />Extra <br />Water