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10. <br />11. <br />OR for rinsing and one for a bleach <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />12. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />Names of responsible persons to bepresent in booth during all hoursof operation13. <br />14. <br />Title <br />\Health Permit <br />1 Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />'X <br />u <br />Propane Tank <br />Bleach and WaterRinse WalerSoap and Water <br />Fire Extinguisher <br />Ice Cooler <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />□ Ice chests <br />□ Refrigerated truck <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches oft of the ground! <br />Stemo w/Chaffing <br />Dish <br />Exira <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waler for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt. <br />PlywoaO, or a Tarp. <br />5-20 Gal <br />Hana wash Water <br />□ Refrigerator <br />□ Ice bath and tubs <br />to ♦ <br />Date <br />^Other (specify) V-AA'' M',VvC-Cvi 0^ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />**lm portant** <br />El 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 <br />booth. hcXYY) <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />M-XUree compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <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 />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 />Completed by:)£r <br />Signature) <br />Cutting Board