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10. <br />11. <br />Tiree compartment sink. <br />OR <br />12. <br />13. <br />Paper towels and a pump-style <br />14. <br />^Important** <br />15.Completed by; <br /> <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Propane Sieve Bleach <br />u <br />Rinse Waler <br />J-Fire Exinquisher <br />I! <br />Pace 8 of 11 TEMP EVENT APP <br />EHD 16-02 <br />7/14/15 <br />Stemo w/C hatting <br />Dish <br />5-20 Gal. <br />Hana wash Water <br />Garbage <br />Can <br />Sanifzer bucks !- <br />bleach a water for <br />storing wiping cteths <br />5 Gal Hans wash <br />Wastewaicr Container <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Title <br />I Propene Tank <br />3^4 f <br />Soap and Water <br />“s foo* beiow <br /> Ice chests [S'fefrigerator <br /> Refrigerated track Ice bath and tubs <br /> Other (specify) <br />Cutting Board ____ <br /> w <br />for soapy wa,er'one for rinsin9 and one for a bteach <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />E^etergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for warewashing: <br />I am ^providing the following cold temperature <br />Signature/ <br />I amproviding the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />• Bwater supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 aallon container with a <br />cSeer.'Ub °r baSin) f°r C°"eCtiOn °f ™"ewater( S^puZ^oan <br />! Ice Cooler '' <br />i___ _ k <br /> <br /> <br /> 3 <br />Extra tea Bags i Food Containers rmst be <br />I stored 6 inches off of the ground! <br />/ ___________________ <br /> <br /> <br />DateZ <br />Names of responsible persons to be present in booth during all hours of operation: <br />sr[