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10. <br />11. <br />OR <br />12. <br />13. <br />14. <br />15.Completed by; <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Culling Board <br />Bleach <br />z-'| <br />Soap and Water Bleach and Water <br />Fire Extinguisher <br />i L <br />Page 6 of 11 <br /> <br />TEMP EVENT APP <br />EHD 16-C2 <br />7/14/15 <br />S Gal Hand wash <br />Waslrwater Conlatner <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 />j/f Refrigerated truck <br />□ Other (specify) <br />Sterno w/Chaffing <br />Olsn <br />Sanitizer bucket­ <br />bleach & water for <br />storlrG wiping cloths <br />S'/zsiiu? <br />Date <br />Propane Stove <br />___de <br />Rinse Water | <br />( Extra \ <br />Water <br />Ice Cooler f ;_____ 1/ <br />Nam^ofrespony le p^s^ns^to be present in booth during all hours of operation: <br /> <br />^Important** <br />extra les Sags 6 Food Containers must be <br />stared 6 inches off of the ground! <br />rY"\ i^^-)-> Gf— <br />-T—..Title <br /> <br />1 am providing the following items within my booth for warewashing: <br />Three compartment sink. <br />** , one for rinsing anri one for a bteach <br />1 am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />^Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />nrenara«°n forJhls ®'?nt A “PV of O’® checklist must be in the booth at aU hours of <br />th7s Zventn 0P8ratl0n- Return original to festival coordinator three weeks prior to <br />fW/n, R-pn rto r <br />Signature <br />Propane Tank <br />' 45’PFrXnd9 £usfXfol^^^ Of potentially hazardous foods below <br />^Refrigerator <br />p Ice bath and tubs <br />Garbage <br />Can <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth-