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10. <br />11. <br />OR <br />12. <br />13. <br />Completed by:14. <br />Health Permit <br />Pap^r Hand TOwel3 <br />Soap diApensef <br />Gutting Board <br />BlescnPropane Stove <br />flfl <br />Propane Tank <br />A <br />Soap and Waler <br />Fire Exllnauisher <br />Ice Cooler <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />Ice chests <br />El Refrigerated truck <br />□ Other (specify) <br />0- Refrigerator <br />□ Ice bath and tubs <br />Exira <br />W9ler <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or s Tarp. <br />St^rno w?Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />SBfMUzer Oucfcet- <br />bleach & water for <br />storing wiping ctaths <br />Water supply dispenser with warm water at a minimum of 100“F (i.e. 5~20 gallon container with spigot). <br />[Z] One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />&2Q Gal. <br />Hand ws$h Water <br />a; <br />I ,i <br />Title <br />0. Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />ZVrk/rb / SrxxJ_______________ ______________________ <br />important** <br />Rlnee Waler | <br />Detergent, 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 />□ Three compartment sink. <br />0.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 />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 wT <br />Signature <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 />Cxtva ice S FOoO containers must be S <br />Stored 5 inches ottoflbo grwndl fie <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: