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r <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils.11. <br />^Q^Three compartment sink. <br />OR <br />S Detergent, bleach and wiping cloths (cleaning towels). <br />-0 Tub to store wiping cloths in bleach solution. <br />12. <br />Water 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 />□ Paper towels and pump-style soap container <br />Names of responsible persons to be present in booth during all hours of operation:13. <br />•’Important*’ <br />Completed by: 14. <br />DateTitleSignature <br />Health Permit <br /> Soap dispenser <br />Cuttinp Board <br />BleachPropane Stove <br />0 ._I <br />B-l-'Rinse Water Bleach and WaterSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APPPage 8 of 11 <br />' Paper Hana Toweis <br />EHD 16-02 <br />08/01/16 <br />>0 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />CfThree 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 />□ Refrigerator <br />□ Ice bath and tubs <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno w/Chaff>ng <br />Dish <br />5 Gai Handwash <br />Wastewater Container <br />Sanitizer bucket­ <br />bleach & water for <br />stonng wiping cloths <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 />Propane Tank <br />5-20 Gai <br />Hand wash Water <br />Garbage <br />Can <br />mi i tm rib ewwwwMiewaiigiiRywiKera <br />Extra Ice Bags 4 Food Containers must be I <br />sfo*ed 6 inches off of tho ground' <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood or a Tarp <br />V. _____________ <br />Extra <br />Water