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P-2831-724-57«*Marty StricklandJun Q1 15 02:36p <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensiis:11. <br />4 <br />12! <br />13. <br />Title DateCompleted by:14.' //'Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Sleach <br />Propane Stove <br />Fina Extinauisher <br />15 Gal Hand wash. Ice Cooler <br /> Refrigerator <br /> ice bath and tubs <br /> <br />Extra <br />Water <br />G3\ce chests <br /> Refrigerated truck <br /> Other (specify) <br />Stems wlChafflng <br />Dish <br />5-20 Gal. <br />Hand wash Water <br />Sanitizer buckst- <br />bieacT & water for <br />storing wiping cloths <br />• Three compartment sink. <br />OR <br />Rinse Water <br />Propane Tank. <br />“Important** <br />J <br />Garbage <br />Can <br />! am providing the foilowiitg cold temperature control for the cold hokting of potentially hazardous foods below <br />45ttF (if food is used the following day, maintain below 41 F temperature). <br />Soap and Water <br />(Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />Oion (one tablespoon of bleach per gallon of water). <br />LDetergent, bleach, and wiping cloths (cleaning towels). <br />'TQSt strips to measure sanitation levels for bleach solution measuring lOOppm. <br />ITKrub to store wiping cloths in bleach solution measuring 10Oppm. <br />lam providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />' booth: <br />^^ier supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />/fjdfoe separate tub (bucket or basin) for the collection of rinse/wastewater. <br />—---------------------kBooth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <br />_____ <br />M Paper towels and pump-style soap container. <br />Nam^s^tf dljrin^ a'1 hours °f operati00 <br /> <br />All food vendor booths are 41113(601 to inspection. Please make a copy of this application in <br />□reparation for this event A copy of this checklist must be in the booth at a” hours of preparation and operation. Return original to festival coordinator three weeks pnor to <br />this event <br />=j1J