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' 107' I am providing the followir potentially hazardous foods below <br />11. <br />OR <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />12. <br />13. <br />14.Completed by: <br />Signature Title Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove Bleach <br />a <br />Rinse Water <br />Fire Extinguisher <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />Jd temperature control for the cold holdir. <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />Slemo w/Chafflng <br />Dish <br />5 Gal Hand wash <br />Was!ewaler Container <br />5-20 Gal. <br />Hand wash Waler <br />Extra <br />Water <br />Sanitizer buckel- <br />bleach & water for <br />storing wiping cloths <br />Extra tea Bags 8. Food Containers must be <br />stored e Inches off of the ground! <br />Soap and Water <br />i <br />Ice Cooler <br />_____ ____Z <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />--- ---------------------/ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Three compartment sink. <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 />Names of responsible persons to be present in booth during all hours of operation: <br /> <br />>ortant** 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 <br /> Ice chests Q3 Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />[SZOther (specify) C <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Q^-One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />TJ ' ...x...... <br />Garbage <br />Can <br />**lmportant*’ <br />Propane Tank ------- ------. .. ,S_ slj <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: