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* <br />10. <br />11. <br />bleachOR <br />12. <br />[X One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />13. <br />C V \ SA i 0 ■ o 'A <x4~rJ) <br />“Important** <br />14. <br />Date <br />Paper Hand Towels <br />Soap ci spenser <br />CtXUna Board <br />Propane Stove <br />Bleacti <br />Btoach and Water <br />sfwedOrncOes oifotthe <br />Page 8 of 11 <br />TEMP EVENT APP <br />1_ <br />Soap and Water <br />2 <br />Rinse Water <br />EHD 16-02 <br />08/01/16 <br />Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />0 Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Siemc w/Chaflrng <br />Dish <br />Ice Cooler j <br />S^titizer bucket- <br />& water for- <br />storing wiping doths <br />I am providing the following for adequate hand washing facilities, but <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />( Extra \ <br />Water <br />Completed by: ^51 VYX£.V\ z? ? <br />~ Signature <br />Health Permit”^ <br />Title <br />most be <br />l am providing the following items within my booth for the sanitary cleaning of food preparation utensils. <br />Names of responsible persons to be present in booth during all hours of operation: <br />~V lyvrtP/XO 7 — AorArk _____Vi r\ I . . u . <br />Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, <br />solution (one tablespoon of bleach per gallon of water). <br />^Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <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 />[ Propane Tan* <br />5 Gal Hand wash _____ <br />VVaslewater <br />one for rinsing and one for a <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />------—/ <br />separate from utensil wash within my