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hazardous foods below10. <br />11. <br />OR <br />12. <br />13. <br />14. <br />Completed by: 15.DateTitleSignature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />.1 <br />Soap and Water <br />Fire Extinguisher <br />1K <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />Rinse Water <br />EHD 16-02 <br />7/14/15 <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br /> Plywood, or a Tarp. <br /> Ice chests [Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />pother (specify) <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Names of responsible persons to, <br /> Water supply dispenser with warm <br />separate tub (bucket or I <br />container. <br />Extra Ice Bags & Food Containers must be K <br />stored 6 inches off of the ground! ■ <br />^Important** <br />Propane Tank <br />I am providing the following items within my booth for warewashing: <br />I^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 />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />^Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />=3l I <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />i water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />onsible persons tcrbepresent in booth during all hours of operation: <br /> s4>A/A-r/ / /vi'cK. ------------------------------------- <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 preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />I am providing the following cold ten., .ature control for the cold holding of poten <br />45°F (if food is used the following day, maintain below 41°F temperature):