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img029.jpg Page 1 of 1 <br />10. <br />11.I am providing the following items within my booth for warewashing. <br />(P'Tfiree compartment sink <br />OR <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils <br />rtergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />"Important'* <br />15.Completed by:-(z TitleSigi Dateire <br />Health Permit <br />1 Pape.- Hanfl ’ o-Aels <br />rHleactiPropane Stove <br />il u <br />Pr opaot- T ank <br />Bieocn and //star <br />Fire Extingwsher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />https://mail.google.com/_/scs/mail-static/_/js/k=gmail.main.en.mGCOBYNtlmE.O/m=m_... 6/20/2016 <br />^71 <br />EHD 16-02 <br />7/14/15 <br />["I 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 />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 />/cbpy of this checklist must be in the booth at all hours of <br />teturn original to festival coordinator three weeks prior to <br />Garbage <br />Can <br />Santizer bucket- <br />bleach 3 water for <br />Stonrig wiping doths <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp <br />□ Water supply dispenser with warm water at a minimum of 100T (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 />Q'lce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />&9gs & Food Cont-nnsrs must be <br />stored 6 iocftes off of the gmurKf1 <br />B^efngerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />wastesvater Container <br />5 20 Gai <br />Kano wash V'.ate <br />Stereo vz/Chrfffittg <br />Dish <br />_z <br />Rtnse Water <br />Names of responsiblqrpersons to be present in booth during all hours of operation <br />Soap and Waler <br />Al! food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event <br />preparation and otferation <br />this event. [\ / //^/ <br />Exits <br />'/Vater <br />Soap dispenser I <br />Cutting Board