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10. <br />11. <br />OR <br />measuring lOOppm. <br />12 <br />13 <br />’'’'Important** <br />14. <br />Signature Date <br />J. <br />Health Permit <br />HandTowii’i <br />Eeach <br />’rcssne ’enk <br />9 ea^* ans Water <br />1/f- <br />Pepe S of 11 <br />Stems wtehatfinj <br />Sat .tzef bucks'- <br />5'S5Sh & #firsr 'or <br />exfra Sapx 4 raoo C-'ints.'^rs musi <br />Sforetf C rchss aro/t^fi gnurtf <br />5 Ge -arj .vesn <br />V/attCn atef Gfr-tahsr <br />=xra <br />sVater <br />Garbage <br />Can <br />E*C 1E-C2 <br />11W14 <br />5-20 Gel <br />Hana wash Wat a* <br />£ .£'.• ..-PP <br />! Refrigerator <br />L^ice bath and tubs <br />Jr <br />Rhfis Water <br />Ice Cooler <br />\^ics chests <br />O Refrigerated truck <br />□ Other (specify) <br />present in booth during al' hours of operation: <br />Title <br />A.i food vendor booths are subject to inspection. Please make a copy of this application n <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 />Completed by: <br />1 afJ-P ?.v,c': g *^e 109 cc'ri temperature contrci for the cold holding cf potentially hazardous foods tele.’' <br />45T (if food is used the following day, maintain below 41 “F temperature): <br />| Soap ar.3 Water <br />■ ___________________________________________________________ <br />“■re Exti’wj r.cr ! <br />I an orot/sCing ths following items within my booth for the sanitary claani.ng of food preparation utensi.s <br />Three compartment sink <br />S Th'ee deep tubs (basins 3-8 inches minimum), one for soapy water, one fo rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water) <br />Detergent, bleach, and wip ng cloths (cleaning towe's. <br />‘ est strips to measure sanitation 'evels for bleach solution <br />Tub to store wiping cloths in bleach solution measuring lOOppm <br />i am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth' <br />st '. va.er supply dispenser with warm water at a minimum of lOO’F -.i.e. 5-20 gallon container with spigot) <br />'fl One separate tub (bucket or basin > for the co lection of nnse/wastewater. <br />Paper towels and pump-style soao container <br />i Soss iwehsar <br />Cu’-t S Board