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to. <br />11. <br />OR <br />12. <br />Paper towels and pump-style $oap container. <br />13. <br />'r <br />TMe <br />Health Permit:’4 <br />PafMtfHarxlTcNMk <br />S<w dtsp®ns«r <br />Cuttna Board <br />PropM Stove Bleach <br />PmearieTar* <br />Soap end Water Rnse Water Bleach and WaterB <br />Fire Extinguleher <br />Page 8 of 11 TEMP EVE NT APPEHO 16-02 <br />08/01/16 <br />5 GatHandwaeh <br />Wastewater Container <br />3-20 Gta <br />Hand wash water <br />Garbage <br />Can <br />O loe chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Stemo arOaerig <br />□ Refrigerator <br />Q Ice bath and tubs <br />Sanitizer buckei- <br />bteach i water for <br />•terino wwing dot* <br />I am providing the folfowing items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />this event <br /><Solis <br />Signature <br />Ice Cooter <br />Extra lea Bag s 3, Food Contiinsra must ba ■ <br />strmd 6 merna off of tha graur.d1 <br />14. Completed by: <br />Nan^^res^si^^y^ns to^^^n^bc^^rino 311 hours °Peration: <br />^-7-/7 <br />Date <br />l^am^provjding toe foltowing for adequate hand washing facilities, but separate from utensil wash within my <br />0Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Booth must be oa <br />Concrete. AsphsR. <br />Plywood, or a Tarp <br />V--------------------- <br />I am providing toe following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (If food is used the folfowing day, maintain below 4IT 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 operation. Return original to ffgtiyal coordinator tfirey Wffcs prfor to <br />[j Three deep tubs (basins 6-6 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 />CTOetergent bleach, and, wiping cloths (cleaning towels). <br />□ Tub to store wiping ctotos in bleach solution. <br />Extra <br />Wald