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1 <br />10. <br />Ice chests <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />OR <br />etergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />12. <br />13. <br />Date rTitle <br />Completed by: 14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board 1 BleachPropane Stove <br />Propane Tank <br />Soap and Water Bleach and Water <br />Fire Extinguisher <br />EHD 16-02 Page 8 of 11 TEMP EVENT APP <br />z_ <br />Rinse Water <br />I am providing the follow, cold temperature control for the cold hold), „ of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41°F temperature): <br /> Refrigerated truck <br /> Other (specify) <br />Extra Ice Bags & Food Containers must be <br /> stored 6 inches off of the ground! <br />Sterno w/Chaffing <br />Dish <br /> Refrigerator <br /> Ice 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, or a Tarp. <br />5-20 Gal. <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />"Nj Water 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 />I <br />_____Z7| <br />Ice Cooler ' <br /> Three compartment sink. <br />OyThree 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 />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 />**lmportant** <br />Paper towels and pump-style soap container. <br />Narn^of resp^sible^ersons to iqejjresent in booth during all hours of operation: <br />I.