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10. i I am providing the following cold tt <br />;e chests <br />I am providing the following items within my booth for warewashing:11. <br />iree compartment sink. <br />OR <br />12. <br />13. lam <br />14.Nam; <br />Completed by:15.DateSignature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />Bleach <br />Propane Stove <br />LPropane Tank <br />Soap and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />7/14/15 <br />[0'Refrigerated truck <br />□ Other (specify) <br />■ '' ^m^rature control for the cold holding of pot; <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />Sterno w/Chaffing <br />Dish <br />Refrigerator <br />fce bath and tubs <br />Extra <br />Water <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, ora Tarp. <br />5-20 Gal. <br />Hand wash Water <br />:flM^?azardous foods below <br />Title <br />ftThree deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />ilution (one tablespoon of bleach per gallon of water). <br />Extra Ice Bags & Food Containers must be ■ <br />stored 6 inches off of the ground! ■ <br />.. a <br />Rinse 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 />providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />z^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />>f responsible persons to be present in booth during all hours of operation: vStoYwei___________ _____________ <br /> T. <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 />Bleach and Water <br />**lmportant**