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. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below10. <br />45°F (if food is used the following day, maintain below 41°F temperature) <br />I am providing the following items within my booth for warewashing.11. <br />□ Three compartment sink. <br />OR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils.12 <br />3 Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth <br />14. <br />OWNERCompleted by 15. <br />Signature <br />Health Permit <br />Papef Hano Towels <br />BleachPropane Stove <br />Propane Tank <br />Rinse WaterySoap ano water <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 1 1 <br />1 <br />I <br />EHD 16-02 <br />7/14/15 <br />□(Ice Chests & FREEZER <br />□ Refrigerated truck <br />□ Other (specify) <br />Eirra Ice Bags & rood Containers must oe <br />stored 6 inches off o* the ground! <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp <br />Stereo w/Cnaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Sa Hand wash <br />Wastewater Container <br />5-20 Gat <br />Hano wash Water <br />| y 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 />Sanitizer bucket- <br />oieacn & water for <br />stenng wiping cloths <br />4.18.16 <br />Date <br />Bleach ano Water <br />Names of responsible persons to be present in booth during all hours of operation <br />HAL MUSKAT_____________ _ ____-________________ <br />“Important*’1 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 weeks prior to <br />thu/event. yy 7 <br />Title <br />r <br />/ <br />I J. <br />1 Ftre ExttTguisner <br />(2 Water supply dispenser with warm water at a minimum of WOT (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 />! Extra \ <br />I Water <br />Soap dispenser j ---------- <br />Cutting Boars