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10. <br />11. <br />OR <br />12. <br />13. <br />14. <br />15.Completed by: <br />7 <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stave Bleach <br /> — <br />Soap and Water Rinse Water Bleach and Water <br />Fire ExlinquisherI <br />Page 8 of 11 TEMP EVENT APP <br />pi I IPI <br />E ' " ...................................~~~ <br />1 <br />EHD 16-02 <br />7/14/15 <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />L*j Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />Title <br />Propane Tank <br />JlllIV <br />Names of responsible persons to be present in booth during all hours of operation- <br />i . ..../ -------------------------------------------------- - ---------------—------------------------------------------------ - <br />‘‘Important** <br />[ Health Permit |l <br />5/4-A <br />/Date <br />.---------------A <br />Ice Cooler i <br />_____ r <br />’***» <br />Garbage <br />Can <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Q'Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />1 a^oPr^‘din9 the f0"T"g 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Boater supply dispenser with warm water at a minimum of 100T (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 />coniamer. <br />I am providing the following items within my booth for warewashing: <br />□ Three compartment sink. <br />S^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 />Extra tee Bags Food Containers must &e 3 <br />stored 6 inches off of the ground! <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />______________/ <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 eyeot. ~ ~———————=-------- <br />Signature