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10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br /> Three compartment sink. <br />OR <br />12. <br />pJi/Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />>ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />13. <br />Completed by: 14. <br />TitleSignature <br />| Health Permit |l <br />Paper Hand Towets <br />Soap dispenser <br />Cuttinp Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11 <br />r <br />- i <br />EHD 16-02 <br />08/01/16 <br />JZfoetergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths In bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />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 />5 Gal Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />£x/ra /ce Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer bucket- <br />bfeach & waler tor <br />storing wiping doths <br />/i : <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />^Other (specify)^v <br />I <br />Ice Cooler"j| <br />'JZ^Paper towels and pump-style soap container. <br />-------------------------------------- <br />‘‘Important** <br />Soap and Water <br />Q <br />Rinse Water <br />'■RtThree 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 />Propane Tank <br />Garbage <br />Can