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8. <br />nn <br />9. <br />OR <br />for soapy water, one for rinsing and one for a bleach <br />10. <br />13. <br />’'Important'" <br />14.Completed by: <br />Health Permit <br />Paper Hano Tornote <br />I CuJLrg Board j <br />Propane S'.cr,o Bloaoh <br />z <br />Page 8 of 11 TEMP EVENT APP <br />EHD 16-02 <br />10/13/09 <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify)___ <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Ga! Hand wash <br />vVastev/alef Conta'nef <br />5-20 Gai. <br />Hand wash Water <br />Garbage <br />Can <br />Stand wEhaflBng <br />Dtsn <br />Sanffizerbucitm- <br />Meach & waterfor <br />storing wpiro doihs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />Ext/a fze £333 & Food CanBmsrs must be <br />stored 6 inches offof!hegmund‘ <br />fret i Mr <br />Title <br />Fire Extngms.'rer <br />Rinse Water I f <br />. M M -- <br />Scao and ’Attar K <br />tun <br />Date <br />SJ Three deep tubs (basins 6-8 inches minimum), one <br />-Solution (one tablespoon of bleach per gallon of water). <br />^Detergent, bleach, and wiping cloths (cleaning towels). <br />j^Tub to store wiping cloths in bleach solution. <br />boothProV'd'n^ 018 followln9 for adscluate hand washing facilities, but separate from utensil wash within my <br />’J™ Pr°vid'n5 the following cold temperature control for the cold holding of potentialiy hazardous foods below <br />45 F (if food is used the following day, maintain below 41T temperature): <br />JS Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth durii <br />Midhcllc- 4 f * <br />Reaai and Water I <br />to be present in booth during all hours of operation- <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. * /> . --------------------------11 <br />I Propane Tank <br />c <br />| Ice Cooler | <br />j Soap ctspenser | _____