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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 />13. <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board 1 BleachPropane Stove <br />1 <br />0 <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />Rinse Water <br />EHD 16-02 <br />11/4/14 <br />H^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 />ETDetergent, bleach, and wiping cloths (cleaning towels). <br />[vffest strips to measure sanitation levels for bleach solution measuring 100ppm. <br />B^Tub to store wiping cloths in bleach solution measuring 100ppm. <br />[vfice chests <br /> Refrigerated truck <br />H Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 <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 />Sterno w/Chaffmg <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />J <br />__________ ~ <br />Health Permit I <br />Title <br /> Refrigerator <br />Q'lce bath and tubs <br />HVVater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />IZfOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />H Paper towels and pump-style soap container. <br />“Important** <br />Oate ■ <br />_5 <br />Soap and Water <br />Names of responsible persons tp be presept in booth duringI all hours of operation: y <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 evenfe', / <br /> <br />Signature <br />Extra /ce Bags & Food Containers must be <br />stored 6 Inches off of the ground! <br />| Propane Tank <br />z J <br />___ <br />a