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10.jf potentially hazardous foods below <br />11. <br />OR <br />□ Detergent, bleach, and wiping cloths (cleaning towels) <br />□ Tub to store wiping cloths in bleach solution <br />12. <br />‘S.Paper towels and pump-style soap container. <br />13. <br />14.Completed by: <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board APropane Stove Bleach <br />J <br />Propane Tank <br />Bleach and Water <br />Tire Extinguisher <br />Ice Cooler <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />Rinse Water <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of the ground! <br />Slemo w/C hatting <br />Dish <br />Exira <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 gallon container with spigot). <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Booth must be on <br />Concrete, A'->pl i.ift. <br />Plywood i.>ra Tarp. <br />'^Refrigerator <br />□ Ice bath and tubs <br />Title Date <br />7 <br />Soap and Water <br />‘‘Important** <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 />I am providing the followir, Id temperature control for the cold hold <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 />5-20 Gal. <br />v" I land wash Waler <br />Names of responsible persons to be present in booth during all hours of operation- <br /> ___4 w \ dn c> I a vvThcz e _ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />QI Three compartment sink. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: y <br />Q] Water supply dispenser with warm water at a minimum of 1 GOT (i.e. <br />®,One separate tub (bucket or basin) for the collection of rinse/wastewater.