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I <br />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 />□ Tub to store wiping cloths in bleach solution. <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />3/15/2025 <br />14. <br />Title <br />1Health Permit <br />Paper Hand Towels <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinfluisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11EHD 1602 <br />08/01/16 <br />0 Ice chests <br />0 Refrigerated truck <br />0 Other (specify) <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 />0 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 />Slerno w/Chaff ng <br />Dish <br />Exira <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />Storing wiping cloths <br />0 Refrigerator <br />0 Ice bath and tubs <br />Names of responsible persons to be present in booth during all hours of operation: <br />(VAnkAmPrl vSrioFiPhP <br /><nhrv.Kn Prd Al l <br />"Important** <br />I Cuttina Board <br />ruVcA'---------------------------------------------------------------—----—....—----------------- <br />TLa eJ i-------------------------------------------------------------------------------------------------- <br />l5f booths are subject to inspection. Please make a copy of this application in <br />A copy of this checklist must be in the booth at all hours of <br />All food vend! <br />preparation for this event. <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />a <br />Extra fee Sags <5 food Containers must be I <br />stored 6 inches off of the ground! <br />Completed by: f^nVwmPrj <S(xr^iig.n^ <br />Signature <br />I &-20 Gal <br />Hand wash Waler <br />I Soap dispenser <br />Soap and Water Rinse Waler <br />z------------------------. <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />*______________z