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10. <br />11. <br />OR <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12 <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Rinse Waler Bleach and Water <br />Tire Extmgu sher <br />Ice Cooler <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />DUu <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 />solution (one tablespoon of bleach per gallon of water). <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 />Stemo w/C hatting <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal <br />Hand wash Water <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood or a Tarp <br />□ ice chests <br />0 Refrigerated truck <br />□ Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[vfWater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />Title <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 />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />[^Paper towels and pump-style soap container <br />Important** <br />5-3-1*? <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />[^Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation: <br />UK K'l'-t-'lL.pv <br />Ext/a Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground' <br />Propane Tank <br />--------------------------J <br />Cutting Board