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10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />0 Three compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />O 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 />0 Paper towels and pump-style soap container. <br />13. <br />‘‘Important** <br />14.Completed by: <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board 3 lBleachPropane Stove <br />I <br />Propane Tank <br />Rinse .Water Bleach and Water <br />Ftre Extinguisher <br />Ice Cooler <br />FMD 1R-n?Pane 8 of 11 TEMP EVENT APP <br />Health Permit <br />S 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 />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />0 Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <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 />Stemo w/Chafling <br />Dish <br />present in booth during all hours of pperation: <br />5 Gal Hand wash <br />Wastewater Container <br />Title <br />Sanitizer bucket­ <br />bleach a water for <br />storing wiping doths <br />Date <br />Soap and Water <br />,2 &Z4 <br />Signature <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Names of responsible persons to be present in booth during all hours of operation: <br />^-4-____f I /h'&Cpf'l <br />All food vendor booths are Wbject 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.