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__ <br />i V vMn my booth for warewashing:n <br />OR <br />XL I VBpBHfcgflmfDfcwing terns wthin my booth for the sanitary deaning of food preparation utensils: <br />EJDrtBgnC htsch, wjmg cloths (deaning towels), and a tub to store wiping cloths in bleach solution. <br />I am faowidng tie fotowing for adequate hand washing facilities, but separate from utensil wash within my booth: <br />••Important** <br />15. <br />Health Permit <br />Pa^w Hmd TomK <br />Soap <**ponMr <br />Cutfing Bosrl <br />Propana Stow <br />Propane Tank <br />Soap and Mar ranaa Water aaachmd Water <br />HroBAvtehar <br />Ice Cooler <br />PageBofU TEMP EVENT APP <br />Sarttaarbuctad- <br />biaacht water for <br />atorinp wfptoQ dotos <br />63afHandwaah <br />WbatewatarConMnar <br />O nmmdteqpMtoK frrwrtir 6-8 inches miwnum), one for soapy water, one for rinsing and one for a bleach <br />MMarnfMettHespoai of bleach per gallon of water). <br />EHD 16-02 <br />7/14/15 <br />□ WAj supply dispenser with warm water at a minimum of 100°F (Le. 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 />StemoWChMno <br />Dtah <br />□ Ice ball and tubs <br />I am pnmdng tie folowmg cold temperature control for the cold holding of potentially hazardous foods below <br />45T (7 food is used foe fotowing day, maintain below 41 °F temperature): <br />Garbage <br />Can <br /> Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <br />Lifoedraris »• <br />□Mvaratadtaa* <br />DOfowtwrWI <br />A <br />J 4^5 <br />Title <br />Extn ks Bag* S Food CtMtahars moi ba l< <br />aMdSWMBcrcfSwgrotaK* ■ <br />Names of resffonsible persons to be present in booth during all hours of operation: <br />Date <br />620 Gte <br />r- HmdwMhWater <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 fo festival coordinator three weeks prior to <br />this event <br />Completed by: <br />\J Signature