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4 <br />10. <br />11. <br />[_• Three compartment sink. <br />OR for sospy water, one for rinsing and one for a bleach <br />12. <br />>f responsible persons to be preps13. <br />Completed by:14. <br />Signature <br />2 <br />=aper Hand T&we?s <br />Cutting Baa'd <br />Pilx^.O <br />Rnse waterSea? sr- Wai®’ <br />| Fire aXtinguisnor <br />' Ice Cooler I; <br />TEMP EVENT APP <br />Pa?e 5 of 11E.HD 1B-C2 <br />Garbage <br />Car. <br />5 Ga: Hand wash <br />Wastwater Car.t^nsrExt'a ize 5h?5 5 Fosd Conrawe.’s rr.-jsi ts <br />stored 5 /nenes od o!tns grovr.^ <br />Stems w’/Cnaffin? <br />Oish <br />□ Refrigerator <br />LJ Ice bath ano tubs <br />5-20 Gal <br />Han: wash Waiar <br />Health Permit - <br />!X Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Sanilzcr Ducket- <br />Diesel & water 'or <br />storing wiping cloths <br />‘"Important** <br />Paper towels and oumo-stvie soao container. <br />Names of responsible persons to be prepent in booth during all hours of operation. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />l am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45CF (if food is used the following day, maintain below 41T temperature/ <br />® Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br />BQ Detergent, bleach, and wiping cloths (cleaning towels). <br />Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />g^Tub to store wiping cloths in bleach solution measuring lOOppm. <br />J am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />iS Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />One separate tub (bucket or basin) for the collection or rinse/wastewater. <br />z------------------------------- <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />L__________—> <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />r=hon for tois “vent A copy of this checklist must be in the booth at al! hours o. <br />prepa radon and’operation'. Return original to festival coordinator three weeks pngrto <br />this event. t I J <br />Title Date <br />! Prcsane Slavs