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10. <br />am providing ?he following items within my booth for warewashing:11. <br /> Three compartment sink <br />12. <br />14. <br />QuJ IS.Completed by: <br />Title <br />Health Permit <br />Paper HflndTpweia <br />Soap dispenser <br />Cutting Doard <br />Propano Stove Bleach1 <br />0T <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinquisher <br />Ice Cooler <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 />Stemo w/Chaffirrg <br />Dish <br />W Refrigerator <br /> Ice bath and tubs <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <br />Garbage <br />Can <br />Ssniteer bucket­ <br />bleach & water for <br />storing wiping cloths <br />'Sj.l Ice chests <br />Refrigerated truck <br />[j Other (specify) <br />Extra ico Hags & Pood Containers must be <br />stored 6 inches off of the ground! <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />___L <br />Soap and Water <br />Date <br />Important** <br />or <br />•fij ; hree 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 />• am providing the following .^,d temperature control for the cold holding o< potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />Signage <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <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 />Names of responsible persons to be present in booth during all hours of operation: <br /> j ________________________ _ <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.