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I <br />10. <br />I am providing the following items within my booth for warewashing:11. <br />□ Threi partment sink. <br />OR <br />'iding the following items within my booth for the sanitary cleaning of food preparation utensils:12.I am pn <br />Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />I am provipling the following for adequate hand washing facilities, but separate from utensil wash within my booth:13. <br />14. <br />Completed by: 15. <br />ignature <br />Health Permit <br />“I Paper Hand Towels <br />Soap dispenser ,1Cutting Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguishera <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11 <br />Soap and Water <br />IF <br />Rinse Water <br />EHD 16-02 <br />7/14/15 <br />M 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 />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 />QFce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <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, ora Tarp. <br />5-20 Gal. <br />Hand wash Water <br />Date <br />**lmportant** <br />u <br />0vVater 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 />Propane Tank <br />jr/ <br />Names of responsible persons to be present in booth during all hours ofpperation:I <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 />Title