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10. <br />11.I am providing the following items within my booth for warewashing: <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 ■■Propane Slovc <br />Propane Tank <br />Rinse Waler <br />! <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />5 <br />EHD 16-02 <br />7/14/15 <br />Q<ce chests <br />LI Refrigerated truck <br />□ Other (specify) <br />Extra lea Bags & Food Containors must bo <br />storod 6 Indios o!f of thn ground! <br />5 Gal Hand wash <br />Wastewaler Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Boolh must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />MM <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />^Jetergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />f Extra \ <br />Water <br />Title <br />y <br />i <br />ii <br /><ECH hree compartment sink. <br />SvThree 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 <br />Soap and Water <br />• Signature <br />**lmportant** <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />\71water 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 soap <br />container. <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 />Names of responsible persons to be present in bopth during all hours of operation: <br />5-20 Gal. <br />Hand wash Waler <br />1 a^r?-y,?'n? the followin9 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 />'ate