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10. <br />pFe faeka^cJ <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />CuttirKi Board <br />BleachPropane Stove <br />Propane Tank <br />Rinse Waler Bleach and Water <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />08/01/16 <br />Extra <br />Waler <br />5 Gal Hand wash <br />Wiistewatfjr Container <br />Sanitizer bucket <br />bleach & waler for <br />storing wifjing cloths <br />□ Refrigerator <br />□ Ice bath and tubs <br />Title <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 bvent. <br />Signature Z' <br />Soap aiKl Water <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />_____________/ <br />I LI j ire Extinguisher <br />mi <br />□ One separate tub (bbcket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container.I <br />Names of responsible persons to be present in booth during all hours of operation: <br />Important** <br />5-20 Gal <br />Hand WMh W;ll«r <br />Steitno w/ClinliltK) <br />; Dish <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespooh of bleach per gallon of water). <br />□ Detergent, bleach, aind wiping cloths (cleaning towels). <br />□ Tub to store wiping tloths in bleach solution. <br />Exfru /cp Bi (p; & Food Containers must be I <br />stored 6 inc ?es off of the ground! <br />I <br />1 thG cold temperature control for the cold holding of potentially hazardous foods below <br />r (li rood is used the following day, maintain below 41 °F temperature): <br />□ Ice chests i <br />□ Refrigerated truck <br />□ Other (specify)____ <br />Garbage <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />b00th i /V/ft - pre /klcfriteyd <br />□ Water supply disperjser with warm water at a minimum of 100’F (i.c. 5-20 gallon container with spigot).