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No. 0563 P. 4SIGNATURE SPORTS GROUP <br />10. <br />I am providing the following items within my booth for warewashing:11. <br />OR <br />12. <br />14. <br />15.Completed by:( <br />J Signature <br />Paper Hand Towel? <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />il <br />Fire Extinguisher <br />13. 2016 12:16PM No. 0693 <br />____ <br />Rlnae Waler <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />B^Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />Exira <br />Waler <br />5 Gal Hand wash <br />Waslewaler Container <br />Garbage <br />Can <br />Sanitizer buckel- <br />b'each & waler for <br />filoring wiping clolhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />H^lce chests <br /> Refrigerated truck <br /> Other (specify) <br /> Slomo w/Chaffing <br />Dish <br /> Refrigerator <br /> Ice bath and tubs <br />5-20 Gal. <br />Hand wash Waler <br /> Three compartment sink. <br />E^frhree 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 />Title <br /><4/3/^ <br />Date <br />Names of responsible persons to be present in booth during all hours of operation: <br />Qhvx-v c^os- _______ <br />W-yytS^L ^0^- <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 eveqt. <br />Received Time Apr. <br />Apr. 1 3.2 0 1 6 3:1 9 PM <br />I am providing the following cola ...nperature control for the cold holding of pL._..tially hazardous foods below <br />45°F (if food is used the following day, maintain below 41°F temperature): <br />‘‘Important** <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />pfWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />1 <br />Soap and Waler Bleacn end Water <br />E>dra Ice A Food Containers must be H <br />stored 6 Inches off of the ground! ■ <br />Ice Cooler ■ <br />_________