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10 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils.11. <br />OR for soapy water, one for rinsing and one for a bleach <br />O Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />13. <br />•‘Important** <br />14.Completed by: <br />>i<Titleire <br />Health Permit <br />Paper Hand Towels <br />Soap dmpensat <br />BleactiPropane Stave <br />Page 8 o/11 TE1UP EVENT APfEHD1M2 <br />«MB1/16 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />O Ice chests <br />O Refrigerated truck <br />O Other (specify) <br />£>*a Ice Btgs t Food Ccntaim must be <br />stored 6 inches off oT the ffmwKff <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 />Stemo ^/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gat Hand wash <br />Wastevater Contaner <br />5-20 Gal <br />Hand wash Water <br />Sanrtizef bucket­ bleach & water for <br />storing vwptng cloths <br />□ Refrigerator <br />O Ice bath and tubs <br />____________/ <br />Ice Cooler <br />4/u>/Z2- <br />Date <br />O Three compartment sink. <br />■<£0 Three deep tubs (basins 6-8 inches minimum), one <br />/Solution (one tablespoon of bleach per gallon of water). <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^3 Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />_______________FCl <>t~l H ex I 1 ______ _____ ___________________ <br />u <br /> <br />I Propane Tank <br />I am providing the folowing 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 />Are ExtinguiVier I ^L. <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />----------- --------------- <br />j Cuffing Board <br />'•re <br />Garbage <br />Can <br />SoapandWater RinseWMw