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1 <br />10. <br />11. <br />□ Three compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cb <br />□ Tub to store wiping clojj in bleach solution. <br />12. <br />□ One separate tub (bucket orbasi: <br />□ Paper towels and pu <br />Names of respj13. <br />Completed by: 14. <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board a BleachPropane Stove <br />0 <br />Propane Tank <br />Bleach and WalerSoap and Water <br />Fire Extinguisher <br />TEMP EVENT APRPage 8 of 11EHD 16-02 <br />Rinse Water <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 />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 />Garbage <br />Can <br />□ Ice chests <br />□ Refrigerated truck <br />^Other (specify)__ <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />I am providing the following for adequate hand washing facilities, byt-sSparate from utensil wash within my <br />booth: <br />5-20 Gat <br />Hand wash Water <br />( Extra \ <br />Water <br />I____I <br />’(cleaning tov^els^^- <br />le^^on^^b^pres^^iMj^oth during all hours of operation: <br />ror soapy water, one for rinsing and one for a bleach <br />■^Important** <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />All food vendor booths are subject to inspection, please make a copy of this application in <br />preparation for this event, <br />preparation and operation. Rj <br />' [/ I sTgnature <br />□ Water supply dispenser with 100°r (i.e. 5-20 gallon container with spigot). <br />t the coition of rinse/wastewater. <br />iyle soap container. <br />A copy of this checklist must be in the booth at all hours of <br />eturn original to festival coordinator three weeks prior to <br />Title Date <br />I am providing the following items within my booth for the sanitary cleaning of food>reparation utensils: □ Threedeep.Ute(toins6-8ln=hes^. <br />Ice Cooler <br />□ Refrigerator <br />□ Ice bath and tubs <br />b AJ F-___fL/