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10. <br />I am providing the following items within my booth for warewashing:11. <br />□ Three compartment sink. <br />OR <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:12. <br />□ Detergent, bleach, wiping cloths (cleaning towels), and a 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 booth:13. <br />Names of responsible persons to be present in booth during all hours of operation:14. <br />‘"Important** <br />15.Completed by: <br />Signature Title Date <br />Paper Hana Towels <br />Soap dispenser <br />J <br />I I <br />Cutting Board <br />BleachPropane Stove <br />•S- <br />Propane Tank <br />Soap ana Water Bleach and Water <br />Fire Extinguisher <br />i Ice Cooler <br />Page 3 of 11 TEMP EVENT APP <br />Rinse Water <br />EHD 16-02 <br />7/14/15 <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 />D 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 />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket- <br />oleach i water for <br />storing 'wiping doths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />n^lce chests <br />-Q^efrigerated truck <br />□ Other (specify) <br />Stemo w/Chaffing <br />Dish <br />B-Refrigerator <br />0Tce bath and tubs <br />5-20 Gal. <br />Hand wash Water <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 />□ 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 soao <br />container. <br />Health Permit I <br />Garbage <br />Can <br />— <br />I Extra ice 3ags i Food Containers must oe O <br /> stored 5 nenes off of the ground1 !