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10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />OR <br />12. <br />□ Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature Title Date <br />Paper Hand Towels <br />BleachPropane Stove <br />n 5^. <br />- - - Z I <br />Propane Tank <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APPEHD 16-02 <br />7/28/10 <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 />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 />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <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 />Stemo w/Chaffing <br />Dish <br /> Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />(Vice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Extra Ice Bags & Food Containers must be <br />stored 6 Inches off of the ground! <br />E^yVater 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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />Tub to store wiping cloths in bleach solution. <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />__________________z <br />"Important** <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash-within my — <br />booth: <br />Garbage <br />Can <br />Names^of responsible persons^o^e^present ir^booth during^all hours of operation: <br />Cutting Board | <br />Soap and Water Rinse Water <br />| Health Permit <br />Soap dispenser