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10. <br />I am providing the following items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:12. <br />□ Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth:13. <br />Names of responsible persons to be present in booth during all hours of operation:14. <br />' Title <br />J-Completed by:15. <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Bleach and WaterRinse WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler J <br />TEMP EVENT APRPanp R nf11 <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 />0 Ice chests <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 />Sterno w/Chaffing <br />Dish <br />[^Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Extra Ice Bags & Food Containers must be | <br />stored 6 inches off of the ground! 3 <br />Date <br />O /<? v/^ — <br />iportant** 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 />‘‘Important’ <br />Health Permit <br />□ Water 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 />---------------------Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Soap dispenser <br />Bleach