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10. <br />11. <br />OR <br />12. <br />13. <br />14.Completed by: <br />.Signatute7 <br />Health Permit <br />Stedi io w/Chaffing <br />• Dish Paper Hand Towels <br />Soap dispensef <br />Cuttinq Board <br />BleachPropane Stove <br />Rinse Water Blead'. and Waler <br />Fire Extinguisher <br />| lIce Cooler <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />Exira Ice Bi qs & Food Containers must be <br />stored 6 inc rt>s oft of the ground' <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket- <br />bleach & water lex <br />storing wiping cloths <br />5-20 Gid <br />Hand vzash Water <br />Civil <br />Title <br />Propane Tank <br />g/'>/2S <br />Date <br /> Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />•‘Important**All fpod 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 />-A <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> Three compartment jsink. <br />0"Three deep tubs (bhsins 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 /> Detergent, bleach, aind wiping cloths (cleaning towels). <br /> Tub to store wiping iploths in bleach solution. <br />I^am^providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />Zfwater supply disperjser with warm water at a minimum of 100 'F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (biucket or basin) for the collection of rinse/wastewater. <br />I am providing the folloyving 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 />0 Ice chests Refrigerator <br /> Refrigerated truck i Ice bath and tubs <br /> Other (specify) i <br />Garbage <br />Can <br />r------------------------------\ <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br /><______ ________/