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10. <br />11. <br />bleachOR <br />utensil wash within my <br />12. <br />13. <br />‘‘Important4* <br />Completed by: I 4? 7 -AytV. <br />Signature <br />14. <br />Date <br />Health Permit <br />Paper Hand Tow^s <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Page 8 of 11 <br />TEMP EVENT APP <br />EHD 16-02 <br />08/01/16 <br />Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />Q Ice bath and tubs <br />Garbage <br />Can <br />Stemo w/Chaffmg <br />Dish <br />S^trtrrer bocfcet- <br />bteach & wader foe <br />storing wiping doths <br />Ice Cooler ■ <br />opener <br />Title <br />i 5-20 Gal. <br />|HarKi wash Water <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp <br />one for rinsing and one for a <br />' P°te"la"V haza <br />( am «»ng Lems within ny booth totthe sanitary cieaning of food preparation utensils; <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 />I am providing the following for adequate hand washing facilities, but separate from <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />[X] One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />'yvxovto 7 — Aor-Ar».____oyAcl C C • On'AccrTT <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 />Rinse Waler <br />5 Gal Hand wash