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• 10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />OR <br />est strips to measure sanitation levels for bleach solution measuring 100ppm. <br />Tub to store wiping cloths in bleach solution measuring 100ppm. <br />12. <br />>ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />JrPaper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Ignature^—Date <br />Paper Hand Towels <br />Soap dispenser <br />Ceiling Board <br />Propane Sieve <br />as <br />PropaneTank <br />Sisach and Water <br />Fire Ex^nguisiteif <br />TEMP EVENT APPPageSofn <br />.................... <br />Health Permit <br />EHO 16-02 <br />11/4/14 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45r’F (if food .is used the following day, maintain below 41 °F temperature): <br />Qj Ice chests <br />Q Refrigerated truck <br />Q Other (specify) <br />Stems w/Chaffing <br />Dish <br />Extra Water <br />5 Gai Hand wash <br />Wastewater Conteteer <br />Garbage <br />Can <br />Sanihzer buckel- <br />bteach & water for <br />storing wiping cloths <br />□ Refrigerator <br />□ Ice bath and tubs . <br />Exira ics & Food Containers must be stored 6 inches of! of the (pound! <br />5-2D Gal. <br />Hand wash Water <br />Title <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />QJ'Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot). <br />I <br />□ Three compartment sink. <br />E^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 />Ice Cooler | <br />Names of responsible persons to be present in booth during ail hours of operation: <br />o ia c 17 p-/ <br /> <br />“Important" 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 />this event. // <br />■h-rr <br />Soap and Water Rinse Water <br />— <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp.___________7