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10. <br />I am providing the follovjlng Items within my booth for the sanitary cleaning of food preparation utensils:11. <br />Q Three compartment sink. <br />OR <br />E Detergent, bleach, and wiping cloths (cleaning towels). <br />r*! Tub to store wiping cloths in bleach solution. <br />12. <br />E Water supply dispenser with wann water at a minimum of 100*F (i.e. 5-20 gallon container with spigot). <br />P<1 One separate tub (bucket or basin) for the collection of rinse,'‘wastewater. <br />E Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Signature <br />Paps Hird "cy.bIj <br />Snap dipenser <br />CusrijBiwC <br />Prcpsni SKva <br />2LJI. <br />Cr.-ywi* <br />El«xh aM Wujsr <br />Hl«i Lx.I UUilra <br />Ice Cooler <br />Page 8 of 1 I TEMP EVENT APP <br />_z <br />Ccap srd iVttr <br />EHD 16 02 <br />(WD1/16 <br />E Three deep tubs (basins 6-S 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 for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providlnf 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 />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 operatioryHte'turn original t« festival coordinator three weeks prior to <br />this event.- . n / /\ <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gdl Hdr dcAKh <br />WMtw.-BterCsnalnr <br />0 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Stciio ivCtfltter; <br />0i-.» <br />S-20 GM <br />Hard-.«sn Wa»r <br />Gartinge <br />Can <br />Booth nitisibe on <br />Concrete. Asphalt. <br />Plyv/ood, or a Tarp. <br />Plrw’Aa>r <br />Owner <br />Title <br />s/n /?? <br />Date <br />"Important** <br />Health Petmit <br />Names of responsible persons to be present in booth during all hours of opeiation:Lakeisha Ingram <br />Lxkru lev i Iced CarnuiWa niur. tv II <br />its rd 6 rcti'ic cT y trie 0 •or.iwl <br />Suri ticv bccUl <br />3 A for <br />jUr.