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10. <br />I am providing the following items within my booth for warewashing: <br />Three compartment sink. <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />Completed by:15. <br />Health Permit <br />1 Paper Hand Towels <br />Soap dispenser <br />Cutting Board J BleachPropane Stove <br />Prepane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11 <br />/ <br />Rinse WaterSoap and Water <br />EHD 16-02 <br />7/14/15 <br />I am providing the following cold temperature control for the cold holding or potentially hazardous fcc-zs below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />CS^Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches oft of the ground! <br />Stemo w/Chaffing <br />Dish <br /> Refrigerator <br /> Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <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, or a Tarp. <br />5-20 Ga). <br />Hand wash Water <br />Extra <br />Water <br />Title Date <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />0'Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />— <br />“Important** <br />Names of responsible persons to be present in booth during all hours of operation:Mu _____________ <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 <br />[Q'-Water supply dispenser with warm water at a minimum of 100°F (i.e. 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 />I i Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />m'b v ' solution (one tablespoon of bleach per gallon of water).