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10. <br />11 <br />OR <br />® Detergent, b t : ? ■ ■ p ng cloths (clear -- ■- <br />12 <br />!K Paoer towels and pump-stvle soap container <br />13 <br />14.Completed by: <br />Signature <br />Health Permit <br />"eper kar.-J <br />Ojttrg fisatd <br />Prcpa-X) St ova S-trsCh <br />-rcoane Tg/ik <br />I I Soap and ’.Valor <br />rif* ~«jngu.s-.cr <br />Peje 3 of 11 ’EV ' EVE’C - <br />ice chests <br />f I Refrigerated truck <br />C Other (specify) <br />iK Test strips to measure sanitation levels for bleach solution measiiting tOOopm. <br />X Tub to store wiping cfotliS in Pleach solution measuring lOOppm. <br />□ Refrigerator <br />ZJ Ice bath and tubs <br />5 Gw -ar.3 wash <br />.Viit.'Adti Corti/.'-.r <br />5<2D Gs! <br />.•■anc Absr Watar <br />EHD 16-02 <br />1WU <br />Siena «*-O.a“ing <br />D’s’i <br />f—" <br />I. / <br />7 <br />Title <br />/______ <br />Rrifis Water <br />X Water supply dispenser with warm water at a minimum o?'OST i.e. 5-20 gallon container with spigot) <br />X One separate tuo (bucket or bas - > -or the co eotior o' r n?- .vast - ater. <br />I <br />-"Important** <br />y <br />Btajh and Waner <br />1 ,the fo!iowin9 cold temperature control for the cold holding of potentially hazardous foods belcw <br />•45 F f food is used die foilowing day, maintain below 41T temperature): <br />7-26-2^ <br />Date <br />E*fF® ite 4 rixto Ca»fawe.-j r-.ust <br />Cfncnss offa'.'hs <br />Xl Three deep tubs (basins 5-3 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 />k-------------------------------------.' . <br />Ice Cooler <br />J f <br />Garbage <br />Can <br />Names of responsible persons to bo presetIfl booth during all hours of operation: <br />J 0fA - jo,Myey <br />Ail food vendor booths are subject to inspection. Please make a copy of this application ;n <br />preparation for this event. A copy of th s 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 />V <br />> Soss sapeissr [ _____ <br />I am prowding the following items within my booth for the sanitary cleaning of food preparation utensils <br />X Tnree compartment sink <br />Sarltzw bucket <br />, Dieeeh & watt'for | <br />I StOfiDi MOi'J j <br />8ootM must be on <br />Concrete, Asphalt <br />Plywood or a Tarp <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: ’