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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 />K Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />KI 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 />□ Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />Completed by: 14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Rinse Water <br />Firo Extinguisherfl <br />Ice Cooler <br />TEMP EVENT APRPago 8 of 11EHD 16-02 <br />08/01/16 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />S 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 />Exira fco Bags & Food Containers must be <br />stored 0 Inches oftotthe ground! <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 />Extra <br />Waler <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Nick Rosales (714)277-5803 <br />Stomo w/Chaffing <br />Dish <br />K Refrigerator <br />□ Ice bath and tubs <br />5 Ga! Hand wash <br />Wastewater Container <br />6-20 Gal. <br />Hand wash Water <br />Sanitizer bucket­ <br />bleach & water (or <br />storing wiping doths <br />General Agent <br />Title <br />6/4/1^ <br />Date <br />rr LZJrL <br />i / <br />Soap and Water