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10. <br />11. <br />OR <br />one for s bleach <br />12. <br />13. <br />14. <br />.ATT <br />15.Completed by: _J <br />Sig :ure <br />Paner Hana Towels <br />Culling Boarc 3Propane Stove <br />Z <br />Propane Tank <br />Rinse Waler <br />Fire Extinguisher <br />Ice Cooler I ! <br />1 <br />Page 8 of 11 TEMP EVENT APPEHD 16-02 <br />7/14/15 <br />Slemo w/Chaffing <br />Dish <br />5 Gal Hana wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket- <br />pleach & water for <br />storing wiping cloths <br />Booth must De on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />□ Refrigerator <br />□ Ice bath and tubs <br />5-20 Gai. <br />Hand wash Water <br />□ Ice chests <br />£><fRefrigerated truck <br />□ Other (specify) <br />Date <br />/ Extra \ <br />Waler <br />Title <br />A,.-'.*li* <br />extra tee flags <5 Food Containors must oe <br />storca 6 inchos of of me ground! i <br />— <br />Soap and Water <br />1 . . <br />Health Permit <br />I am providing the following items within my booth for warewashing: <br />•Sf Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and <br />solution (one tablespoon of bleach per gallon of water). <br />Names of responsible persons to be present in booth during all hours of operation- <br />A <br />"Important” 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, events------------- <br />I 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 />1 am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />£mVater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soa_p <br />container. <br />1 amoProvidin9 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 />Sieach ar>d Waler I ' <br />J—s