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10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />OR <br />H^Detergent, bleach, and wiping cloths (cleaning towels). <br />EkTub to store wiping cloths in bleach solution. <br />12. <br />EEhA/ater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />------ —14.Completed by: <br />Signature DateTitle <br />Health Permit <br />“1 Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Propane Tank <br />Soap and Water Bleach and Water <br />Fire. Extinquisher <br />Ice Cooler <* <br />Page 8 of 11 TEMP EVENT APPEHD 16-02 <br />08/01/16 <br />L^Three compartment sink. <br />[LpThree 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 />CEHce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />0T5ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />H'Paper towels and pump-style soap container. <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/Chaffing <br />Dish <br />Extra <br />Water <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 />LETRefrigerator <br />□ Ice bath and tubs <br />5-20 Gal <br />Hand wash Water <br />B <br />■ <br />B <br />.........mm................................................ 7 <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 />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 />, <br />Rinse Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />- M „ .11/ <br /> rrzTT _ <br />i Cutting Board