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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 />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />12. <br />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 collectton of rinse/wastewater. <br />Q Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />ignature <br />Paper Hand Towels <br />Soap dispenser <br />Guttinn Roarrl <br />BleachPropane Stove <br />CPropane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Page 8 of 11 TEMP EVENT APP <br />Health Permit <br />EHD 16-02 <br />11/4/14 <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash 'within my <br />booth: <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 al! hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. ZA <br />Sterno w/Chaffing <br />Dish <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 />□ Ice chests <br />□ Refrigerated truck <br />Q Other (specify) <br />Extra Ice Bags & Food Containers must be ® <br />stotod 6 Inches off uf the ground! E <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I <br />Title <br />**lmportant** <br />^Refrigerator <br />□ Ice bath and tubs <br />) (_) ( <br />Names of respons^^ersons^g^^re^ent in b^^^ring^alljnours^opei^t^m^/ <br />Ice Cooler i <br />F <br />I am providing the following ^td temperature control for the cold holding ot potentially hazardous foods below <br />45DF (if food is used the following day, maintain below 41°F temperature): <br />ri' <br />i <br />— <br />■ i ) r? <br />" I <br />Soap and Water