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I <br />11. <br />O Throo compartment sink. <br />OR <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />“Important** <br />Completed by.15. <br />Title <br />Prtptv Hnmi ttiwds <br />J <br />Ctrtlino Itoaid <br />fJIeachPtopatta Stovfl <br />OIvRdi tWKi WM<¥Soap ond Waler <br />Piro Pxllnuiiistwi <br />'1 <br />TL’MP EVGNTAPPPagn n of 11 iCHD 10-02 <br />7/M/I 5 <br />Skvrw w/ClyMnj) <br />Olsh <br />I I Refrigerator <br />£3jce bath and tubs <br />fxlra <br />Waler <br />5 Cal Hand Wish <br />Wusfowalef Cunlninur <br />5-20 Gnl <br />Hiind wash WntO! <br />Gaibage <br />Can <br />O Throo 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 waler). <br />i <br />flee Cooler <br />Health Permit a <br />‘I.. <br />Fxlra Im OiiQs £ Food Cont,v'nofs must <br />stuivf.! d Indira oil of tln> giowdi <br />Ice chests <br />□ Refrigerated truck <br />I I Other (specify). <br />j Swtitizof Ixjcktrt. <br />bloadt & walor for <br />I slwn<i wiplrtfl ctolhs <br />I Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41°F temperature): <br />Date <br />I am providing the following items within my booth for warewashing: <br />Mfr <br />' N'f\□ Water supply dispenser with warm water at a minimum of 100T (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 sgap <br />container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />fffeixa. \Aihl ovvapL _:____________________ <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. Roturn original to festival coordinator threo weeks prior, to <br />this event. <br /> <br />Signature <br />RIihu Water j <br />12. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />A) n <br />□ Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />3 fr <br />Hmmiu T-wik <br />Sot<p divpuiiyut