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10. <br />11. <br />□ Three compartment sink. <br />OR <br />12. <br />13. <br />//ZCompleted by:14.DateSignature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />J <br />Rinse Water <br />Fire Extinguishera <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />> <br />Extra <br />Water <br />EHD 16-02 <br />11/4/14 <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify)_ <br />Sterno wChaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />5-20 Gal. <br />Hand wash Water <br />Title <br />Soap and Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />_______________) <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 />N 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 />□ 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 items within my booth for the sanitary cleaning of food preparation utensils. <br />Garbage <br />Can <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 />Names of responsible persons to be present in booth during all hours of operation: <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/ J / /