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10. <br />I <br />11. <br />OR <br />12. <br />13. <br />Paper towels and a pump-style <br />14. <br />Important* <br />15.Completed by: <br />Signatijr4 <br />Paper Hand Towels <br />Soap dispenser <br />Propane Stove Bleach <br />Propane Tank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />'Z <br />J <br />Page 8 of 11 <br /> <br />TEMP EVENT APP <br />EHD 16-02 <br />7/14/15 <br /> <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />5 Gal Hand wash <br />Wastev/ater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />□ Refrigerator <br />□ Ice bath and tubs <br />•I <br />5-20 Gal. <br />Hand wash Water <br />Sterno w/Chaffinc <br />Dish <br />— <br />Health Permit - <br />I am providing the following items within my booth for warewashing: <br />0"Three compartment sink. <br />( Extra <br />Water <br />(WL <br />Title <br />otentially hazardous foods below <br />7^ M - I <br />Date <br />Ice Cooler i • <br />I / Extra Ice Bags & Food Containers must be <br />~ ' stored 6 inches off of the ground! <br />I am providing the following <br />45°F (if food is used the foil <br />for soapy water'one for rinsin9 and one for 3 b,each <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 />I temperature control for the cold holding <br />lowing day, maintain below 41OF temperature): <br />Names of responsible persons to be present in booth during all hours of operation: <br />_________________16oV\ \)p*rO'r i <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />S^rSrh,hP?|!.y £tfePer1S®r (warm water at a minimum of 100’F (i-e. 5-20 gallon container with spigot). A <br />b b Or baSln) fOr the collectlon of nnse/wastewater. Paper towels and a pump-style soao <br />cu n ia I n © r. ------— <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. 7 “ ~ ---------- <br />/ l//1M <br />TT _ <br />zzzd <br />Soap and Water <br />Cutting Board