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10. <br />11.I am providing the following ilems within my booth for the sanitary cleaning of food preparation utensils. <br />□ Throe compartment sink. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels) <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />[^AA/atcr supply dispenser with warm water at a minimum of 100 F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater <br />Paper towels and pump-style soap container. <br />13. <br />+ <br />Completed by: 14. <br />Signature Title <br />Health Permit <br />ul lowcl'. <br />ip dispenser <br />Bltii n ilPion.iire Slove <br />Prop.ine 1 .ink <br />Fire Extinquisher <br />Ice Cooler <br />T^MPFVFNT APRPage 8 of 11FHD 1(5 02 <br />08/0V K5 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 Bays & Food Containers must be <br />stored 6 inches off ol the yround1 <br />□ Refrigerator <br />□ Ice bath and tubs <br />Exira <br />Waler <br />5 Gal I lanrt wash <br />Wastewater Containei <br />Gi ii bagc <br />Can <br />Booth must be on <br />Concrete; Asphalt, <br />Plywood, oi a Tarp <br />0H-CC chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Sterno w C'.halfiiu] <br />Dish <br />Sanitizer ini' k''i <br />al" I, ii K iit-r foi <br />.Ipiiihi wipmij ( lollr, <br />Date <br />Rinse Water <br />Names of responsible persons to bo present in booth during all hours of operation <br />, jap mi Fem rxfid -Anod/’e Sri pan ^iTViCt <br /> <br />All food vendor booths arc subject to inspection Please make a copy ol this application in <br />preparation for this event. A copy of this checklist must bo in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event. <br />“Important*/) <br />SjJTiree deep tubs (basins 6-8 inches minimum), one for soapy water, one tor rinsing and one for a bleach <br />solution (one tablespoon of bleach per gallon of water) <br />__1 <br />Soup ant! Water <br />CutliiKi Board