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10. <br />11. <br />OR <br />12. f am providing the foliowing items within my booth for the sanitary cleaning of food preparation utensils: <br />M Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />15.Completed by: <br />Titleig nature <br />Papar Hand Towels <br />Soap dispenser <br />Cultina Board <br />BleachPropana Stove <br />Propane Tank <br />RinseWafer Bleach and WalerSoap and Waler <br />Flro ExlliwdsherQ I <br />Ice Cooler <br />I <br />TEMP EVENT APPPage 8 of 11EHD 18-02 <br />7/14/15 <br />[vf Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Sam Hissayko <br /> <br />O' 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 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 />Slerno w/Chaffing <br />DIMi <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanilizar huckat- <br />bleach & water for <br />storing wiping clolhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following items within my booth for warewashing: <br />Ej Three compartment sink. <br />Extr& Ice Bags A Food Containers must be <br />stored 0 inches oil of the groundl <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 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. x------ <br />Refrigerator <br />□ Ice bath and tubs <br />Exira <br />Water <br />J <br />“Important** <br />04/15/2016 <br />Date <br />■i <br />Health Permit 3