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. 10-illy hazardous foods below <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink <br />OR <br />©iSetergent, bleach, and wiping cloths (cleaning towels; <br />lu/Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />to store wiping cloths in bleach solution measuring lOOppm. <br />12. <br />13 <br />14.Completed by: <br />Signature <br />Paper Hand Towels <br />Soas sispenssr <br />Propane Stove Bleach <br />3 L <br />Propane Tank <br />E eaoh and Water <br />r <br />Pago 8 of 11 TEMP EVENT APR <br />Q^Vater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Z&'6ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />E5>ftiree 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 />5/4ce chests <br />F] Refrigerated truck <br />n Other (specify) <br />Stemo w/Chaffing <br />Olsh <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hard wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Ex'fra ice Bags & Focd Contarnars rr.us! be <br />stored C inches offotihe ground! <br />5-2D Gal <br />Hand wash Wats' <br />EHD 16-C2 <br />11/4/14 <br />i Health Permit <br />.1 <br />Ij^/F'aper towels and pump-style soao container. <br />Names of responsibl€p^^g^jo be in^otl^du^^a^h^s ^^peration: <br />Sanilzerbuckei- <br />oleaeh & A-ater for <br />storing wiping cloths <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 al! hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this evgfrt, <br />vT <br />Extra ’ <br />Water <br />/°///^ <br />Date <br />"Important** <br />; Soap and Water <br />Fire Extinguisher i <br />Ice Cooler 1 i <br />Title <br />1 am providing the following ci amperature control for the cold holding of pot <br />45T (if food is used the following day, maintain below 41 °F temperature): <br />r <br />Rinse Water I