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10. <br />12. <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />15.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire extinguisher <br />u I <br />Soap and Waler <br />I 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 /> 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 />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 />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <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 /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />Stemo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />( <br />Ice Cooler <br />Health Permit <br />T <br />:~:r •; <br />Extra tee Bags fi rood Confa/ners must be <br />stored 6 inches off of the ground! <br />----1 <br />Important** <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 />Refrigerator <br /> Ice bath and tubs <br />Signature \ Title ' Date <br />11. lam providing the following items within my booth for warewashing: <br />Three compartment sink. <br />OR <br />Names of responsible persons to bepresent in booth during all hours of operation: <br /> <br />Cutting Board