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10.potentially hazardous foods below <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />OR <br />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Tub to store wiping cloths in bleach solution <br />12. <br />p] Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />PI Paper towels and pump-style soap container. <br />13. <br />**lmportant** <br />Owner 5/12/1714.Completed by: <br />Title Date <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Waler <br />Tire Extinguisher <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />____________ <br />Health Permit I <br />Rinse Water <br />0 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth. <br />Extra Ice Bags 4 Food Containers must be <br />stored 6 inches off of the ground' <br />Slemo w/Chaffmg <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <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 ora Tarp. <br />pl 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 />Names of responsible persons to be present in booth during all hours of operation: <br />Vince Truong <br />Extra <br />Water <br />5 Gal I land wash <br />Wastewater Container <br />5-20 Gal <br />I land wash Water <br />I am providing the following c_.j temperature control for the cold holding ut <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />rZ <br />Soap and Waler <br />Ice Cooler <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. <br /> <br />Signature