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temperature control for the cold holding <tentially hazardous foods below <br />11. <br />OR <br />12. <br />Pai >r towels and pump-style soap container. <br />13. <br />A vx I <br />14.Completed by: <br />Signature Title <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Soap and Water Rinse Water Bleach and Water <br />Fire Extinguisher <br />: Ice Cooler <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Sterno w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Extra <br />Water <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />□ Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />I am°providing the following < temperature control for the cold holding c <br />45°F (if food is used the folic...ng day, maintain below 41 °F temperature): <br />j/^ce chests <br />I I Refrigerated truck <br />□ Other (specify) <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />' 10. <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 nnor to <br />this event. — ---------- <br />Names of responsible persons to be present in booth during all hours of operation: <br />.. 4s------_____________<2^1__ IJikH <br />___ ------------------------------- <br />"Important <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Three compartment sink. <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />j ^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution vone tablespoon of bleach per gallon of water). <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />^(fub to store wiping cloths in bleach solution. <br />booth pr°VldinS thS f0,l0W!nS f0! adeclljate hand washing facilities, but separate from utensil wash within my <br />Soap dispenser <br />Bleach