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10. <br />I <br />11.I am providing the following items within my booth for warewashing: <br />□ Three compartment sink. <br />OR <br />I <br />13.I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />15.Completed by: <br />Signature <br />Health Permit <br />Paper Ha-Td Towels <br />Soap dispenser <br />Culling Board <br />BleachPropane Stove <br />Bleach and Water <br />Fire Extinguisher <br />Page S of 11 TEMP EVENT APP <br />I <br />EHD 16-02 <br />7/14/15 <br />□ 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 />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <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 />□ 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 />□ 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 />Stemo w/Chafflng <br />Dish <br />Extra <br />Water <br />5-20 Gai. <br />Hand wash Water <br />Ice Cooler <br />_______7 <br />i. <br />i: <br />Soap and Wator <br />Propane Tank <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />J^foetergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />“Important** <br />Names of resporisibte persons to ^.e present in booth during all hours of operation: <br />a <br />Rinse Water <br />Cxtra Ice Bags & Food Containers must be E <br />stored 6 Inches off of Ibo ground/ (a <br />(^2 <br />Tine