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10. <br />I am providing the foilowing items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />12. <br />E Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution <br />13. <br />14. <br />“Important** <br />Completed by: 15. <br />Health F’ermit <br />Paper Hand Towels <br />Soap dispenser <br />.1 Bleacfi <br />Propane Stove <br />Propane Tank <br />Bleach and WaterSoap and Water <br />Fine <br />i Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />i <br />EHD 16-02 <br />7/14/15 <br />Stemo w/Chaffin^ <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanibzer bucket- <br />Weach & water for <br />storing wiping doths <br />Boaft must be <br />Concrete, Asphalt. <br />Plywood, or a Tarp. <br />g] 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 />Extra ice Bags & Food Containers must be <br />stored 6 inches off of the ground1 <br />0 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Water <br />5-20 Gai <br />Hand wash WaterJ <br />5 u <br />Title Date <br />/ <br />Rinse Water <br />A copy of this checklist muS be in the booth at ail hours of <br />Return original to festival coordinator three weeks prior to <br />Names of responsible persons to be present in booth during all hours of operation. <br /> ________ !/ --------------------------- ------------------------------------- <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />prepara ton fix this event <br />preparation and operation <br />this event <br /> <br />^/Signature <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth <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 />[2 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />Cutting Board