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□ Three compartment sink. <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />Paper Hand its <br />Soap dispenser <br />Cutting Board <br />Bleachle Stove <br />I <br />Bleach and Water <br />Fire Extinguisher <br />TEMP EVENT APPPage 8 of 11) 16-02 <br />11/16 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods beloy <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleac <br />solution (one tablespoon of bleach per gallon of water). <br />Slemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Booth mus be on <br />Concrete, / sphalt. <br />Plywood, or a Tarp. <br />□ Ice chests <br />□ Refrigerated truck <br />Qf Other (specify)__ <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />1 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 m/ <br />booth: <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />_z <br />Soap and Water <br />IT U <br />Rinse Water <br />14. <br />Sanitizer bucku <br />bleach & water I r <br />storing wiping de ns <br />I10. <br />V-I Ib/l# 2. <br />Date <br />12 i I <br />| Health Permit <br />111I <br />aneTank <br />Ice Cooler ■LZZZ Extra Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground! <br />Names of responsible persons to be present in booth during all hours of operation: <br />**lmportant** All food vendor booths are subject to inspection. Please make a copy of this application <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return prioinal to festival coordinator three weeks prior <br />this event. <br />Completed by: Q <br />Signature Title