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,�� �� Q�`�] ,� Environmental Health Departme-ill <br /> A. <br /> IC. I am providing the following cold temperature control for the cold holding of potentially hazardous foods belo%v <br /> 45-F (if food is used the following day, maintain below 41'F temperature), <br /> r,s Ice chests Refrigerator <br /> 1 Refrigerated truck F] Ice bath arid tubs <br /> Oliver(specify)__--.. <br /> i i ;I am providing the following items within my booth for the sanitary cleaning of food preparation utensrl <br /> It J Three compartment sink, <br /> OR <br /> �_J Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a 011.oc r <br /> solution (one tablespoon of bleach per,gallon of water). <br /> k Detergent, bleach, and wiping cloths(cleaning towels), <br /> [_!Tub to store wiping cloths in bleach solution. <br /> I am providing the following for adequate hand washing lacilitius. but separate from utensil wash wW)in rrr! <br /> booth: <br /> r�2 Water supply dispenser with warm water at a minimum of 100F(i.e. 5-20 gallon container with SWIM', <br /> �20ne separate tub(bucket or basin)for the collection of rinselwastewater• <br /> .)\Pnper towels and puma-style soap container. <br /> 13. Names of responsible persons to be present in booth during all hours of operation: <br /> "Important" �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 w all hours :, <br /> preparation and operation. Return orlainal to festival go2rdlnat2r thrpQ w@eks prior-to <br /> this 9yent. 7 <br /> '14. Completed by: __.�.j. ' !/ i rp_i4�, 01/12/24 <br /> Signature Title Date <br /> I Health Permit <br /> l r, i f I ..rr:re:r� h.�• ,P <br /> • r � ---- I��eT.:na�tit.i-. r:� 4P L". �L _ call� G��r l <br /> Ice Cooler f- <br /> t.aa roe w,;s b Foua crr:wws•a•v,er rr I tti a•:r�,r••�� :+•."• i ( <br /> Jr S <br />