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11. <br />OR <br />12. <br />13. <br />14.Completed b <br />Paoer Hani Tcw»i» <br />P'opane Stove Bleach <br />S*1 <br />Propane Tw* <br />Soap and Water Rmae Water Blwch mm Water <br />/O\ <br />Water <br />fvo Extngwshw <br />Ice Cooler <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />SlertK) w/Chafttng <br />Orth <br /> Refrigerator <br /> Ice bath and tubs <br />Garbage <br />Can <br />5-M Gal <br />Hand wash WaterHealth Permit <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> Three compartment sink. <br />^SUhree 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br />O Tub to store wiping cloths in bleach solution. <br />TitleSignature Date <br />Swizm budwH- <br />W»«ch & wawtr tor <br />Monng wrpnaaofr, <br />| Booth tnust be on <br />• i i Concrete, Asphalt <br />Plywood, ora Tarp <br />SGMHwMwaih <br />WaztewMwCnMMner <br />^am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />-jg^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />D One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />O Paper towels and pump-style soap container. <br />Ekm m Btgt & Food Contamwt tmiu t» H <br />itnredflincMsotfoffMgniuntf' S <br />10. I am providing the following cole .nperature 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 />ice chests <br />' Refrigerated truck <br /> Other (specify) <br />— <br />preparation and operation. Return original to festival coordinator dime weeks prior to <br />this events <br />Cutting Board <br />Soap Ouponwr