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10 <br />11 <br />□ Three compartment sink. <br />OR <br />for soapy water, one for rinsing and one for a bleach <br />O Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />□ Tub to store wiping cloths in bleach solution measuring lOOppm. <br />12. <br />O 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 />O Paper towels and pump-style soap container. <br />It. <br />7 2-c, r? <br />IDate ' <br />Completed by.14. <br />Paper Hand Towels <br />Cutting Board <br />Bleach3ropane Stove <br />r <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />_____L <br />Soap and Water <br />L <br />Rinse Water <br />E4D 16-02 <br />11l 74/14 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods b^low <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ice Bags & Food Containers must de <br />stored 6 inches off of the ground! <br />Stemo w/Chaffing <br />Dish <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 />Extra <br />Water <br />& <br />X,________ <br />Bleach and Water <br />Title <br />□ Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br />■^.Detergent, bleach, and wiping cloths (cleaning towels). <br />Propa e Tank <br />.............. r _ I <br />□ Refrigerator <br />□ Ice bath and tubs . i <br />£ooouk\\ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />"Important** <br />Names of responsible persons to be present in booth during alUnours of operation: <br />□ Ice chests <br />□ Refrigerated truck <br />^Other (specify) <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 />| Signature Tj <br />HealthTermit11'1^ <br />| Soap dispenser j - <br />1