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10. <br />11. <br />OR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils.12. <br />0 Detergert, bleach, wiping dClhs tdearmg towels), and a tot to store wiping clutos in Meath solution. <br />13. <br />14. <br />"Important** <br />Completed by:15. <br />Health Permit <br />Paper Hana Towels <br />Soap dispenser <br />BleachPropane Stove <br />2 <br />Propane Tank <br />Rinse Water <br />X <br />Fire Extinguisher <br />I <br />TEMP EVENT APRPage 8 of 11EHD 16-02 <br />7/14/15 <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 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 />Names of responsible persons to be present in booth during all hours of operation: <br />Ruben Caballero <br />I am providing the following items within my booth for warewashing: <br />0 Three compartment sink. <br />Stemo w/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Exira <br />wctw <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 G^. <br />Hand waah Watar <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp, <br />Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Sanitizer bucket- <br />blaach & water for <br />storing wiping datfis <br />Representative <br />Title <br />May 2, 2016 <br />Date <br />Soap and Water <br />f' ''a', .'jrit*' '- <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Water supply dispenser with warm water at a minimum of 100°F (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 />Extra Ice Bags & Food Containers most be <br />stored 6 inches off of the ground! <br />||..X _ <br />T"" ''...........I-*..::.-:- •II - <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 operatio/i. Return original to festival coordinator three weeks prior to <br />this event . /! <br />/ / ^Signature <br />J <br />/ <br />Ice Cooler H