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10. <br /> Three compartment sink. <br />OR <br />12. <br />14. <br />important** <br />C! IoCompleted by: 15.'Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Rinse WaterSoap and Water <br />Ice Cooler <br />TEMP EVENT APPPage B of 11EHD 16-02 <br />Rece i ved Time Jun. 9. 2016 1:59PM No. 4393 <br />1 <br /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <br /> Refrigerator <br /> Ice bath and tubs <br />Garbage <br />Can <br />SanitJzor buckot- <br />bteacft & water for <br />fttodng wiping dolhs <br /> Booth must be on <br /> Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Stsmo w/Chftfflng <br />Dish <br />5 <3b1 Hand wash <br />Wastewater Container <br /> <br />I Propane Tank <br />I Fire ExtMigutehW <br />0 Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />Sutton (one tablespoon of bleach per gallon of water). <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />tentially hazardous foods below <br />S-20 Grf- <br />r- Hand wash Water <br />11. lam providing the following items within my booth for warewashing: <br />Ilf <br />Gxlro Icq Bags & Food Cantsinors must b6 |a <br />sforad fl Inotioa oft of the ground! EJ <br />I am providing the following cold temperature control for the cold holding of pott <br />45’F (if food is used the following day, maintain below 41 F temperature). <br />Names of responsible persons to be present in booth during all hours of operation: <br /> ft/frin (t______ ___________________________ _____ ___ <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 jprialnal to festival coordinator three weeks pnor to <br />this event, <br />Signature <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />‘kj Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with * <br />separate tub(bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style, soap <br />container. <br />C^li'Ou <br />/I Title ' <br />Exira <br />Water