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' 9. <br />□ Other (specify) <br />10.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 />ub to store wiping cloths in bleach solution. <br />11. <br />□ Paper towels and pump-style soap container. <br />12. <br />13.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Bonrd <br />BleachPropane Stove <br />nI tzT T <br />Bleach and Water <br />Fire Extinguishera <br />Ice Cooler <br />Page 8 o( 11 TEMP EVENT APPEHD 16-02 <br />Title <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Extra Ico Bags & Food Containers must bo <br />stored 6 inches off of the ground! <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />^Q"VVater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />^Q^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Ice chests <br />□'Refrigerated truck <br />REC-001-B <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 />Stomo w/Chafdng <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer hucket- <br />bleach i water for <br />storing wiping cloths <br />Propane Tank <br />/Soap and Waler Rinse Waler <br />^JZfRefrigerator <br />JZi Ice bath and tubs <br />‘Important** 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. /f <br />SignktuFe <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 />Names of responsible persons to be present in booth during all hours of operation: