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<br />10. <br />11. <br />OR <br />12. <br />Completed by:14. <br />IHealth Permit <br />1 Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Propane Stove <br />Bleach and WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11EHD 16-02 <br />11/4/14 <br />[^’Refrigerator <br />O ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterna w/Chaffing <br />Dish <br />Sanitizer bucket­ <br />bleach & "water for <br />staring wiping«cloths <br />a <br />Rinse Water Garbage <br />Can <br />(i‘■hr: <br />Signature <br />"Important** <br />i— <br />Propane Tank <br />.......... i * <br />preparation for this event. <br />preparation and operation. <br />this event. <br />i <br />Extra Ice Bags & Food Containers must be <br />stored 6 snches off of the ground! <br />Title <br /> Ice chests <br /> Refrigerated truck <br />' Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />[l2fThree compartment sink. <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 />H^Detergent, bleach, and wiping cloths (cleaning towels). <br />Q^st strips to measure sanitation levels for bleach solution measuring 10Oppm. <br /> Tub to store wiping cloths in bleach solution measuring 10Oppm. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[/water supply dispenser with warn water at a minimum of tOO'F (l.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. • Names^f^ponsiblep^sons^bep^ent in booth during all hours of operation: <br />All food vendor booths are subject to inspection. Please make a copy oi: this; app!icat^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