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potent,--iHy hazardous foods below10 <br />I Am providing ihp following ih>m^ w.ihir. my Ix^th for ?h#> ^mtAry cfA^nmQ of food preparation utensils:11 <br />□ Thw compel sink <br />OR <br />O Deterpent, blench, and wipmq cloths (clonnmq towels). <br />I ] Tut? to store wiping cloths in bleach solution <br />12. <br />'"S Water supply dispenser with warm water at a minimum of IQO’F (i.e. 5-20 gallon container with spigot) <br />S One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />fi^Paper towels and pump-style soap container. <br />13. <br />14. <br />DateSignature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />=1Soap and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TtMP EVE NT W <br />iI <br />EHD 16-02 <br />08/01/16 <br />O Three door tubs (basins 6 fl inches minimum), onn for soapy water, one for rinsing and One for a bleach <br />solution (one tablespoon o< bleach per qalion of water). <br />Stemo w/Chaffmg <br />Dish <br />( I Ro’nqnraliv <br />[ I l< « tv»th And tubs <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 Tag <br />Extra Icg Rags <S Food Containers roust be <br />stored 6 indies off of the groundl <br />5-20 Gal. <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />Extra <br />Water <br />■ <br />Bleach and Water <br />Title <br />2 <br />Rinse Water <br />I am prnvM’jmQ th© fciHciwinq coiri lomp^r^ttup r>oriirr^ fnr thP rriVf hof<lfO<5 of <br />46 F (it Ick'KI is UAOd the kiik>wn>q <J,«y m.itrM,i»n betow 41 F T^m^r-Mura) <br />JCf fee chests <br />[/) Refr/cjerekM truck <br />CT Other (spoctfy) <br />Km <br />Names of responsible persons to be present in booth during all hours of operation: <br />“important** ' 'Ali 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 />Completed by:/\zY