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w. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />pf Three compartment sink. <br />OR <br />JZ) Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping doths sh trfesch solution. <br />12. <br />□ Water supply dispenser vwth warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub ^dtet or basin) for the collecton of rinse/wastewater. <br />.QT’aper towels and pump-style soap contamer. <br />13. <br />Completed by: 14. <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />■t I' <br />A <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11EHD 16-02 <br />08/01/16 <br />□ 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 fotowng for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />■1 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 />A8 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 ewent <br />Stemo vvOhaffirng <br />Dish <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />□ Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />Sianati <br />Soap and Water <br />Signature <br />C/ y - / Z <br />Title <br />fe persons to be present in booth during all hours of operation: <br />\ VHWfr- <br />-------------------------\ <br /> Booth must be on <br />Concrete, Asphalt, <br /> Plywood, or a Tarp. <br />Garbage <br />Can <br />Extra Ice Bags & Food Containers must be I <br />stored 6 Inches off of the ground! | : <br />Names of responsibte <br />“Important**