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10. <br />I am providing the following items within my booth for warewashing:11 <br />□ Three compartment sink. <br />OR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:12 <br />Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth:13. <br />14.Name] <br />Completed by: 15. <br />ro <br />Pap-' Hand TowcU <br />Soao dttosrw <br />tUeucnPropane Sto*e <br />r <br />P-opane Tank <br />H-ruK.* and Watw <br />F ire O'jnouiherQ <br />Ice Cooler t <br />I- <br />Xl.Water supply dispenser with warm water at a minimum of 100uF (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 />S»mo wJChaffing <br />DhTi <br />□ Refrigerator <br />Fl Ice bath and tubs <br />5 Gal Hand wash <br />Wattowaw CdiUino' <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45qF (if food is used the following day, maintain below 41 °F temperature): <br />E rta <br />Water <br />Garbage <br />Can <br />SamUrcr buckol- <br />bkaacn & water lor <br />Storing wiping cloths <br />Extra Ice fiagt t Focd Ccnfsmri must tx> <br />stored 6 inebet otl ol Ibt gnjjnd' <br />Date <br />LU _z <br />Hm» Waler <br />-----------------“i <br />Health Permit <br />Important** <br />J3.lce chests <br />F 1 Refrigerated truck <br />Fl Other (specify) <br />it in booth dunng all hours of operation: <br />_L <br />Soap and Waler <br />ffiThree 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 />responsible persops to/ie present in <br />Co- mw r <br />Titler <br /> <br />All food vendor booths arc 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 />prfiparatipo_and operation. Return original to festival coordinator three weeks prior to <br />tnisi ev^nt^T X /