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10. <br />11. <br />OR <br />12. <br />Ol <br />13. <br />'DatefCompleted by:14.Date <br />.Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />A <br />Propane Tank A <br />Rinse Water <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />11/4/14 <br />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />^fce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />5-20 Gal. <br />Hand wash Water <br />A <br />Ice Cooler I <br />I* : ■■ i .~r~ — <br />iter supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />pe separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Title <br />| Soap and Water <br />□ Three compartment sink. , <br />S/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 />"^Detergent, bleach, and wiping cloths (cleaning towels). <br />Test strips to measure sanitation levels for bleach solution measuring 10Oppm. <br />Tub to store wiping cloths in bleach solution measuring 100ppm. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Paper towels and pump-style soap container. <br />of responsible persons to be present in booth during all hours of operation: <br />_ <br />1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <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 />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! . <br />All food vendor booths are <br />preparation for this event, <br />preparation and operation. <br />this event. <br />Signature <br />Names of respor <br />‘‘Important**subject to inspection. Please make a copy of this application in <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />Garbage <br />Can