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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 />.*★ <br />Date <br />14. <br />Title <br />1Health Permit <br />Paper Hand Towels <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire Extinpuisher <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11EHO 16-02 <br />08/01/16 <br />0 Ice chests <br />□ 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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: z <br />Sterno w/Chaffmg <br />□•sb <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping dolhs <br /> Booth must be on <br />Concrete, Asphalt, <br /> Plywood, or a Tarp. <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 />5-20 Gal <br />Hand wash Water <br />j Cutting Board <br />h <br />a <br />| Soap dispenser <br />r""1"Extra Ice Bags i Food Containers must be I <br />stored 6 inches off of the groundl <br />Names of responsible persons to be present in booth during all hours of operation: <br />DAo hAtnPrl 7 -------------------------------------------------------------------------—............ — <br /><o )ir\.m /M i Do-ry cj i......................................................................................... — <br />**lrnportant** 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 />Soap and Water Rinse Waler <br />Completed by: rCnMa-tnPrj <br />Signature