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J <br />8. <br />9. <br />OR <br />10. <br />13. <br />>4 <br />•’Important" <br />14.Completed by: <br />Health Permit <br />Paper Hana TowgIb <br />Soap dispenser <br />| Cuffing Board | <br />Propane Stove Bleach <br />Fire Extinguisherif <br />Ice Cooler fi <br />Page 8 of 11 TEMP EVENT APR <br />go n pr <br />Title <br />EHD 10-02 <br />10/13/09 <br />0 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />fr?l Refrigerator <br />□ Ice bath and tubs <br />5 Gai Hanc wash <br />Wastowaier Containef <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sanitizer bucket- <br />WeachA water for <br />storing wping clothe <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Three compartment sink. <br />ill <br />-■■■ <br />Slatno wOsfflng <br />Dtah <br />Extra kx Bags & Food Contonars must be <br />stored S etches off of the ground1 <br />Names^pf responsible person^to be presen^in booth during <br />aEEHSSss <br />Breach and WaterScap ano Water <br />Garbage <br />Can <br />5-20 Gal. <br />r- Hand wash Water <br />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 />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 /> <br />[ Propane "ank <br />blMthPr0V'din9 ,h6 f0"OWin9 fbr adst’uate hand washing facilities, but separate from utensil wash within my <br />ns to be present in booth during alHujurs of operatiorv-x7 HoU__sQ <br />AI1 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 />WiTsev n”1 and yatlon/Betur^ric|'nal to festival coordinator three weeks prior to <br />-----i. \ " ■__clodp r P'/lzSl /zo /G <br />Signature Title Dite ' ' <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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />Rmsa Water 1 i <br />[ Exira \ <br />Water