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10. <br />11. <br />OR <br />12. <br />(Q^Paper towels and pump-style soap container. <br />13. <br />•‘Important** <br />14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Propane Stove <br />0c <br />Propane Tank <br />Bloacti and Water <br />Ftro Fxlinguishcr <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11 <br />Title <br />EHD 16-02 <br />07/3/17 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot), <br />[yi^One separate tub (bucket or basin) for the collection of rinse/wastewater. <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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <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 /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify)______________ <br />Ico Bogs A Fcxxl Containers must txi <br />stored 6 inches off al the ground! <br />Slerno w/Chnffu>g <br />DtsJ> <br />5 Gal Hand wash <br />Wastowator Container <br />Booth must be on <br />Concreto, Asphalt. <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />5-20 Gal. <br />Hand wash Wall* <br />Garbage <br />Can <br />Date <br />Extra <br />Water <br />Sanitizer bucket­ <br />bleach A waler lor <br />storing wiping cloths <br />Rinse Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />________________ <br />J <br />Soap and Water <br />| Soap dispenser j <br />I J <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: <br />Culling Hoard