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Potentially hazardous foods below <br />OR <br />12. <br />13. <br />14. <br />15.Completed by: <br />ture <br />Health Permit - <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board 1Propane Stove <br />0r.. Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />Soap and Water Rinse Water <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />Sterno w/Chaffmg <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />EHD 16-02 <br />7/14/1.1 <br />0\Refrigerator <br /> Ice bath and tubs <br />Sanitizer bucket­ <br />bleach & water (or <br />storing wiping cloths <br />( Extra \ <br />Water <br />Extra Ice Sags & Food Containers must be <br />stored 6 inches o!f of the ground! <br />Title Date <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 />10. - I am [ <br />45°F (if food is used the ft, <br />11. lam providing the following items within my booth for warewashing: <br />£3 Three compartment sink. <br />^Important** <br />providing the following —'d temperature control for the cold holding <br />. rf ,e . jng dayj maintajn be[ow 41 op temperatur£ <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />i^ Wa‘er s“PPly 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 />coniainor. <br />Names of responsible persons to be present in booth during all hours of operation: <br />—< g y v? z, Y>V) A, ftsQ <br /> <br />El Jinn® <basi"s ®-8jnches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />Bleach <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 eveqt. ' ---------------------------