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Aug. 23. 2018 12:08PM No. 5135 P. 10 <br />10. <br />11.I am providing the following Items within my booth for the sanitary cleaning of food preparation utensils: <br />OR <br />\QyTub to store wiping cloths In bleach solution measuring 100ppm <br />12. <br />13. <br />Important** <br />Owner 8/22/2018aCompleted by:14. <br />Title DateIgnature <br />Health Permit <br />Paper Hand Towels <br />Soap dkpenser <br />Cui Dog Board <br />Propane Slave <br />Bieacii and WalerRinse WalerSoap and Waler <br />Fire Extinguisfw <br />Ice Cooler <br />TEMP EVENT APRPag®a OF 11 <br />34^0 chests <br />□ Refrigerated truck <br />□ Other (specify), <br />Garbage <br />Can <br />Ssnldzorbudrel- <br />Wesdi &watsrfor <br />etartng wljtfng doltu <br />Booih must ba on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />Q^etergent, bleach, and wiping cloths (cleaning towels). <br />tb^Tfest strips to measure sanitation levels for bleach solution measuring 100ppm. <br />Sterbd w/Chuffirtg <br />Dish <br />HXefrigerator <br />□ Ice bath and tubs <br />Ellra <br />Waler <br />6 Gal Rand wash <br />WasUfivater Contain er <br />5-20 Gal. <br />Harxl wash Waler <br />Names of responsible persons to be present In booth during all hours of operation: <br />_ Michael Speer, Katie brown-------------------------- <br />Cxira & Food ConlQrws most ba B <br />siowdGhctesofloflhegfomdl ■ <br />Received Time Aug. 23. 2018 12:11PM No. 4035 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />□LVt/ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />C^dne separate tub (bucket or basin) for the collection of rinsefwastewater. <br />Q^Pgpdr'towels and pump-style soap container, <br />□ Three compartment sink. <br />□ Jflree deep tubs (basins 6-fl inches minimum), one for soapy water, one for rinsing and one for a bleach <br />elution fane 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 />preparajfon and opjtaUwW*Q.turn original to festival coordinator three weeks prior to <br />ttfls event. <br />Propane Tank <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41’F temperature):