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209-727.-31 1 p. 1Tim f shr <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />□ Three compartment sink. <br />OR <br />@ Detergent, bleach, and wiping cloths (cleaning towels). <br />P Test strips to measure sanitation levels for bleach solution measuring IQOppm. <br />B Tub to store wiping cloths in bleach solution measuring lOOppm. <br />12. <br />IJ] Water supply dispenser with warm water at a minimum of 10O’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 />13. <br />“Important** <br />14.Completed by: <br />Title <br />j Health Permit <br />Paper Hand Tonwto <br />BleachPropane Stove <br />IE <br />Propane Tank <br />Bleach and Water <br />Ice Cooler m.-.•J <br />TEMP EVENT APPPaseBof 11EHD 16-02 <br />11/4/14 <br />0 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 for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following cold temperature control for tee cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />Exfn Bags & Fcod Containers must be <br />stored 6 inches oft at the gmurxll <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 weeks prior to <br />this event <br />□ Refrigerator <br />□ Ice bate and tubs <br />5-20 Gal. <br />Hand wash Water <br />Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Swmow/Cnaffino <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />SannMreuckM- <br />bteachS water for’ <br />storing wiping doth* <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />/O| <br />water <br />ir_Z <br />Rinse Water <br />J <br />j r_L <br />Soap and Water <br />Names of responsibly persons to be present in booth during all hours of operation: <br />j Fire ExtinguisherEr <br />Soap dispenser