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w. <br />11. <br />OR <br />[Ss-Oetergent, bleach, and wiping cloths (clean -• ■ <br />12. <br />13 <br />"Important <br />K 0 <br />Title <br />Health Permit <br /> <br />Cutt .’g Baa'd <br />[Prcpfl'M? Stove Breach <br />a-O-o / <br />Prcoane * ank <br />J Soap arti Waler ? tar1' and Water <br />L <br />Pass » ofti 'E7’ E'. = \- .'.sp <br />U Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />O Tub to store wiping cloths in bleach solution measuring lOOppm. <br />5 G* -ar a wasn <br />/•'iiT-.v, ater Cof.i'cr <br />fioolh must be on <br />Concrete. Asphalt <br />Pl/wood or a Tarp. <br />EHD 16-C2 <br />IIWU <br />Sice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Stcn> w/Cfta*^ □fen <br />Sar.lzor Lucke:- <br />slssch 4 wsurfor... <br />C*fra izt B»$s t PtyM Cy*fai<»-x nus‘ h# <br />Sfi.'cJ Cr'neres aTc/ATs j" <br />5-20 Gel <br />Hanc wtsh v/atr <br />I <br />□ Refrigerator <br />LJ Ice bath and tubs <br />Skater supply dispenser with warm water at a minimum of 103T (i.e. 5-20 gallon container with spigot.) <br />\<Cne separate tub (bucket orbas im for the collection o' rmse.'wast--.-ter. <br />Spacer towels and pump-style soap container. <br />Completed by: <br />Signature <br />e? i sts.' <br />Date <br />Rhss Water I <br />!------------------ r-aper HwdTOwQH <br />• - . dT ___J <br />Garbage <br />Can <br />Ice Cooler <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 checkl’st must be in the booth at all hours of <br />preparation and operate-. Return original to festival coordinator three weeks prior to <br />this event. <br />LJ fhree deep tubs (basins 6-3 inches minimum) one for soapy water, one for rins ng and one for a b'each <br />solution (one tablespoon of bleach per gallon of water) <br />Names of responsible persons to be present in booth during all hours of opera-..-.n <br />_ <br />1 the f0J°-7n9 cold temperature control for the cold holding of potentially hazardous foods below <br />4b t- (it food Is used the following day, maintain below 4l’F temperature): <br />I am providing the following for adequate hand washing facilities but separate from utensil wash within mv <br />booth: <br />l k <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils. <br />□ Three compartment sink