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10.temperature control for the cold holding oi potentially hazardous foods below <br />11. <br />OF. <br />12.! 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 />13. <br />14. <br />15.Completed by: <br />Title <br />Health Permit <br />Psp«r Hand Towoia <br />Soap dispenser <br />Cutting Board |1Propane Stovs.Bleach <br />0T <br />Pfonane Tank <br />Rinse Water Bleach and Waler <br />Fire Extinpuisher <br />Ice Cooler <br />□ ice chests <br />□ Refrigerated truck <br />Q Other (specify) <br />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />am providing the following items within my booth for warewashing: <br />L.I Three compartment sink. <br />Extra leo Hags i Pood Containers must be <br />otorod 6 inches off of the ground1 <br />5-20 Gal <br />Hand wash Water <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <br />Sanitiser bucket­ <br />bleach & water for <br />storing wiping cloths <br />I am providing the following ^.u 1 ‘ L J <br />45°F (ir food is used the following day, maintain below 41 °F temperature) <br />Signature \Date <br />Soap and Water <br />i hree 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 /> <br />‘’‘Important^ <br />Names of responsible persons to be present in booth dunng all hours of operation <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 />i am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <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/wastewaxer Paper towels and a pump-style soap <br />container. —--------