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10. <br />11. <br />OR <br />12. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Htieiergent, 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 />u*15.Completed by: <br />Date <br />Papnr Hand Towels <br />Soap dispenser <br />BleachPropane Slave <br />n <br />Propane Tank <br />Bleach and Walar <br />]Fire Exilnowlaher <br />ice Cooler <br />stored 6 inches oft of the ground! <br />PajaBof 11 TEMP F.VEHT APReno 16-02 <br />7/14/15 <br />Boater 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 soap <br />container. <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 following items within my booth for warewashing: <br />□'three compartment sink. <br />Lrflce chests <br />O Refrigerated truck <br />O other (specify^ <br />5 Gal Hand wash <br />WssiGWaier Container <br />Extra <br />Waler <br />Garbage <br />Can <br />Slamo w/Chaffing <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Sanltizor bucfcel- <br />blaach & waler for <br />storing wiping cloths <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (If food is used the following day, maintain below 41 °F temperature): <br />□ Refrigerator <br />O Ice bath and tubs <br />I <br />I <br />Ci 0/1. _______________________ __________________ _____________ _ <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. <br />Title <br />Ekfre lea Bago & Food Gonloinora must bo '■ <br />stored 6 inches off of the gmundl J <br />Names of responsible persons to be present In booth during ail hours of operation: <br />Ci) _______________________________________ <br />yi/Ztxj/Ulf <br />‘important** <br />aofl <br />1 <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />y Signature ' <br />Health Permit « ------------------- <br />Soap and Waler Rinse Water