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10. <br />11. <br />OR <br />12. <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />••Important** <br />Completed by. 14. <br />Health Pennit <br />Paper Hand TcwBii <br />Soap dcpeoMr <br />Propene Stove <br />Propane Tank <br />Rre ExdrxjLHher <br />Ice Cooler <br />Page 8 at 11 TEMP EVENT APPEHD 16-02 <br />06/01/16 <br />Exira <br />WaW <br />SGdHandvmsh <br />WaatowMer Container <br />&-20 Gal. <br />Hand wash Water <br />Garbage <br /> Can <br />□ Ice chests <br />^^Refrigerated truck <br />□ Other (specify) <br />KI One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />J^Paper towels and pymp-style soap container. <br />Stomo wChaffing <br />Di* <br />Q Refrigerator <br />□ Ice bath and tubs <br />Sanitzer bucket- <br />«eetf> 4 water tor <br />storing wiping doths <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Title <br />L <br />Soap and Water <br />r <br />Rlnta Water <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 tablespoon of bleach per gallon of water). <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />'')^Tub to store wiping cloths in bleach solution. <br />of responsible persons to be <br />■ KAaUVriln <br />Exn k» Btgt l Food Contiinen mu^ ba <br />ttmdomaiasoirottrvtround! <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 />to be oresent in booth during all hours of operation: <br />A ki rij ______________________________________ <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 ffpstiyal coordinator three weeks prior to <br />thh event, / <br /> <br />7 Bfariature' <br />Btoadimd Water