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p.2 <br />10. <br />□ <br />11. <br />□ Thj»e compartment sink. <br />OR <br />a bleach <br />tergent, bleach, and wiping cloths (cleaning towels). <br />ub to store wiping cloths in bleach solution. <br />12. <br />□ W< <br />kaper towels and pump-style soap container. <br />13, <br />operation. Retui nal to festival coordinator three weeks prior to <br />14.Completed by: <br />Signature <br />Health Permit <br />Raper Hard Tovrefs <br />Outtinp Board 3Rnpano Stove Bleach <br />Propane Tank <br />Rinse Water <br />Fire Extinguisher <br />Page 8 of 11 TEMP EVENT APPEHO 16-02 <br />08/01/16 <br />Mice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Refrigerator <br />fee bath and tubs <br />Sanlttzjsr tucket • <br />Moadi & water tor <br />storing wiping doths <br />too Bays « FtwcT Coruekie/s nn/st z>e <br />sto/ad 6 fncMs effofthv ground! <br />Slomow/Chaffing <br />Cish <br />5 Gal H. nd wash <br />Wartewak r ConHncr <br />fWete*" <br />Title <br />z <br />Ooap and Waler <br />I Ice Cooler j , <br />i <br />**lmportanF* <br />Date <br />:r supply dispenser with warm water al a minimum c f 10O'F (i.e. 5-20 gallon container with spigot). <br />One/separate tub (bucket or basin) for the collection of ri ise/wastewater. <br />g1- <br />Garbage <br />Can <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for <br />solution (one tablespoon of bleach per gallon of water). <br />5-20 Gal. <br />Hand wo«h Water <br />I am providing the following items within my booth for the se nitary cleaning of food preparation utensils: <br />I am ^providing the following cold temperature control fortf:e cold holding of potentially hazardous foods below <br />45 F (if food is used the following day, maintain below 41 ’F temperature): <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />•------------------------------ <br />l^an^ providing the following for adequate hand washing I acuities, but separate from utensil wash within my <br />Soap dis leaser I ______ <br />jO <br />Bieacn and Waler <br />Names of responsible p^sws to be present iiti booth during iall hours of operation: <br />pWAA <br />All food vendor booths are subject tort/s pection. Please make a copy of this application in <br />preparation for this event A copy of tjhis checklist must be in the booth at all hours of <br />preparafjerraT' <br />this fftrent./