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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 />O Detergent, bleach, and wiping cloths (cleaning towels) <br />^3\Tub to store wiping cloths in bleach solution. <br />12. <br />WWater supply dispenser with warm water at a minimum of 100'F (r e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />J^Paoer towels and pump-style soap container. <br />13. <br />“Important** <br />Completed by,14. <br />DateSignature <br />Health Permit <br />Paper Hand TowcH <br />S4«OMP«nt* <br />Carino Bow <br />Blown <br />r <br />Bieacn wd Wx* <br />Fro Ertnouarw <br />TEMP EVENT APRPage 8 of 11 <br />Ersra <br />EHD 1602 <br />0601/16 <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 />lee I Foot nmtM <br />5Ga H*-x5 wasn <br />5-20 Gat <br />HvtdwasnWator <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />E3Jce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />□ 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 />□ Refrigerator <br />M Ice bath and tubs <br />Stcmc wi'Cnaf'.ng <br />buckci- <br />bJeach A wate* k* <br />storing cw^ <br />OkfilAWie- <br />Title <br />I <br />Soap and Wai* <br />Ice Cooler <br />esponsible persons to be present <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 />Ihis event <br />Names of responsible persons to be present in booth during all hours of operation: <br />Prooane Tank --------------»