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10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Three compartment sink. <br />OR <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0Tub to store wiping cloths in bleach solution. <br />12. <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />tyT Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature <br />a <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />I |r <br />Propane Tank <br />Soap and Water Rinse Water <br />3 <br />Page 8 of 11 TEMP EVENT APP <br />4 <br />EHD 16-02 <br />7/28/10 <br />Names of responsible persons to be present in booth during all hours of operation: <br />Sam Hissayko <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 /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <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 />Exfra Ice 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 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[Zf Refrigerator <br /> Ice bath and tubs <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />_____________ <br />Health Permit <br />Owner <br />Title <br />11/01/2016 <br />Date <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 /> 71 I I <br />"Important** <br />Garbage <br />CanP Fire Extinguisher