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10. <br />impartment sink <br />OR <br />for soapy water, <br />li12. <br />13. <br />my booth: <br />14.Namesof resi ^present all hours of operation: <br />ooths are subject to Inspection. Please make a copy of this application In <br />jperation. Return original to festival coordinator three weeks prior to <br />15.Completed by: <br />Title Date <br />Health Permit <br />Pgpw Hand Towels <br />Soap disptnspf <br />CuttJog Boeid <br />Propane Stovo Bleach <br />iJilPropene Tank <br />Fire <br />Page 8 of 11 TEMP EVENT APP <br />IlfilHiBliiESg) <br />Mtitnor. must bo <br />gmund! I <br />Rinfre Water <br />EHD 16-02 <br />7/14/15 <br />□"Wter supply dispenser yiith <br />separate tub (bucket or 1 <br />container. ; <br />Ej Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Sanitfiar bwAal- <br />Waach A waier for <br />stpring 'MpingcioOii <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />txtra Ice Bats 4 Awe/i <br />tlored 4 Inches ~ <br />3t»fno <br />I Man <br />Garbage <br />Can <br />£ GBl Hand wash <br />Wnstawster ConU(n&r <br />• A <br />and a pump-style soap <br />i <br />i ________ <br />Signature <br />i <br />i <br />/ Extro \ <br />Water <br />I <br />Gf'Three deep tubs (beisinsj 6-8 ijchee minimum), one <br />solution (one tablespoon of b each per gallon of water). <br />ismproy^g the following U ms u jthio my booth for the sanitary leaning of food preparation utensils: <br />Sl5etergent, bleach, wiping |loths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />one for rinsing and one for a bleach <br />Ice Cooler & <br />il <br />**lmportant** <br />1 —“y <br />i Iii <br />liI <br />11. lam providing the following items ■ vithln my booth for warewashing: <br />El Three compartment sink.! i <br />II I <br />soap no Water <br />I LjRefrigerator <br />□ Ice bath and tubs <br />Bleach and Wsiar <br />B^tergent, bleach, wining Jpoths (cleaning towels), and a tub to store wiping cloths in bleach <br />I : <br />i am providing the following fty adequate hand washing facilities, but separate from utensil wash within <br />er With w^rm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot), <br />basin) for the collection of nnse/wastewater. Paper towels and a pump-style so <br />i <br />sib^ersQ1al1 hours of operation: <br />All food vendor ~ ----------- <br />preparabort for his event. A copy of this checklist must be in the booth at all hours of <br />preparation and —4**“ rw-A— » • •• <br />this eveni'1 n <br />IXba ;~r <br />5-20 Gid. <br />Hand wish Water