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I am providing the following items within my booth for the sanitary cleaning of food preparation utensils9. <br />I ! Three compartment sink <br />OR <br />10 <br />separate tub (bucket or basin) for the collection of rinse/wasrewater <br />;^/^aper towels and pump-style soap container <br />Names of responsible •rsons to be present in booth during all hours of operation13 <br />14.Completed by <br />/ Title <br />Health Permit <br />1 Paper Hano ’ <br />So4p dww.iet <br />Cu&rg ticM’i <br />Prepare Stc.-e <br />Propane lar k <br />)Bteacn a*xj Wifir <br />“re Er’njutsnw <br />i <br />Ice Cooler <br />I <br />/ <br />Rsoie A'aierS oar and A'awr <br />I I Refrigerator <br />i^lce bath and tubs <br />j '..iI Hand wash <br />.Vastewaier (.<HT*-npr <br />Sarvtaw Uvwet- <br />tieach J. wa2« tor <br />sJoorx} wong cltxhs <br />( <br />I <br />P rfra <br />Waler <br />Garbage <br />Can <br />Booth must be oi <br />Concrete Asphal <br />Plywood or a Fanb <br />SignabXe^^/Wr <br />f Date <br />Q^fub to store wiping cloths in bleach solution <br />c«h <br />J^Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />j[^6etergent. bleach, and wiping cloths (cleaning towels). <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth <br />ifj'Water supply dispenser with warm water at a minimum of 100°F (i e 5-20 gallon container with spigot) <br />i <br />. 3 ‘ am Providin9 ^6 following cold temperature control for the cold holding of potentially hazardous foods below <br />45 F (if food is used the following day. maintain belpw 41 °F temperature)' <br />chests <br />□ Refrigerated truck <br />n Other (specify)~_ <br />5 20 G® <br />r~ Hsr a wash A'a'"-' <br />I <br />I .-rj » I mwMj he <br />| 5 ‘'••s j“ y r** <br />if resoonsibie o^rsons to be present in booth during all hours of operation <br />—m -....-.------ <br />Important** 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 />thiy event <br />/ <3