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IV. <br />I am providing the following Items within my booth for warewashing:11. <br />OR <br />• 14. <br />Date ' <br />15. Completed by: <br />Paper Hand Towels <br />Culling Board <br />Propane Stova <br />7^-I <br />Fire Extinguishera <br />iIce Cooler J <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gat Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Sanitizer bucket- <br />Maach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, ora Tarp. <br />Health Permit <br />□ Three compartment sink. <br />Cf 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 />Slerno w/Chaf/ing <br />Dish <br />Title <br />is of responsible persons to b; <br />L SdVjin * <br />i <br />:: <br />i am piuviuiiivj ti iv ivbuvviii^ vajiu i^inpcioiuic; guiki vj ivi uiu» vuim uuium^ tn <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />0 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Extra Ice Begs A Food Containers must be <br />stored G inches oil of the ground! <br />/I <br />Signature <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />q/ Water supply dispenser with warm water at a minimum of 10O’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 />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />pj Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />IICU-UIVIW-I MVIV'.u <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 />)e present in booth during all hours of operation: <br />_ <br />Nairjes of responsii <br />\<OA CaY\ <br />..ZIZ <br />‘"Important** <br />Propanp Tank