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11. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />Water supply dispenser with warm water at a minimum of 10O’F (i.e. 5-20 gallon container with spigot). <br />O One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />Bleach <br />Propane Stove <br />Propane Tank <br />Bleach and Water <br />S Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Extra Ice Bags & Food Contafners must be <br />stored 6 inches off of the ground! <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Ifl <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Stem© w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />''jj'^Three compartment sink. <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 />Title <br />Soap and Water Rinse Water <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br /> "Impoi^it** AITfood vendor booths are subject to inspection. Please make a copy of this applicatiorTin <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 />J LL_* m <br />Ice Cooler ! j <br />_________ <br />I am KIVV>MIIIM me iviiWKvmy vvim icnipe.amie eeliuei mi me avia nemmy ui pwieiiuany nat-ameuo iuuuo aeiw«» <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br /><____________—/