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10. <br />chests <br />11. <br />OR <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />Q Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br /> Tub to store wiping cloths in bleach solution measuring 100ppm. <br />12. <br />13. <br />Title <br />Completed by: 14. <br />I <br />Paper Hand Toweie <br />Soap dispenser <br />Gutting Board <br />BleachPropane 5tov» <br />Propane Tank <br />4 <br />Bleach and WaterRinse Water <br />Fire Extinguisher <br />TEMP EVENT AFPPaae 8 of 11 <br />5 Gai Hand wash <br />Wastewata' Container <br />GanlUzar buokel- <br />bleach 4 waler for <br />Storing wiping oiolha <br />Stemo w/Chaffing <br />Dlth <br />Garbage <br />Can <br />5-20 Gal. <br />Hend wash W ft tar <br />Ice Cooler <br />EHD 16-02 <br />Received Time May. 28. 20 1 5 1 2:22PM No. 8847 <br />"Important** <br />Extn let Bags & Pood Conteinorv mudt bo ■ <br />atorod 6 tnohaa off of thv g'Ovodf R <br />3oap and Water <br />| Health Permit <br /> Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />pother (specify) _____________—------- <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />^yTIlle^ 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 />|Z <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />_______________/ <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />^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 of rinse/wastewater. <br />>^Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation j <br /> fT-FAolntP 1I I I Itf a ky ~ fel 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 wwks Prior to <br />this event. <br />Extra <br />Watar