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10. <br />11. <br />OR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:12. <br />f^| Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth:13. <br />14. <br />‘‘Important** <br />Completed by: 15. <br />Papor Hand Towels <br />Soap dispenser <br />Culling floor<1 <br />BleachPropane Stovo <br />I <br />Propane Tank <br />Bleach nr,d Waler <br />Ice Cooler <br />TEMP EVENT APPPago B of 11EHO 16-02 <br />7/14/15 <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <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 41OF temperature): <br />Refrigerator <br />Ice bath and tubs <br />Extra <br />Water <br />5 Gnl Hentl wash <br />Waslowalir Conlalnor <br />Garbage <br />Can <br />Sanitizer buckel- bleach a waler for <br />storing wiping dolhs <br />I am providing the following items within my booth for warewashing: <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 tablespoon of bleach per gallon of water). <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />1 •-AH <br />Health Permit <br />tkgr- x-j.-ai-*;.,'-a a^i'iV’.- ^2)'I <br />F.tlra Ice Bags A Food Containers rmul bo I <br />stored 6 Inches oil ol the ground! J <br />Title <br />.5-6-/7 <br />Date <br />Rinse Wuler <br />'7 <br />Soap end Walin <br />i. <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. ,7 <br /> <br />Signature <br />Names of responsible persons to be present in booth during alt hours of operation: <br />HjWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />Fire Exliixiulther j <br />5-20 Gal <br />Hand wash Walor <br />itomo