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10. <br />11. <br />OR <br />12. <br />E) Paper towels and pump-style soap container. <br />13. <br />•'Important** <br />14.Completed by: <br />Health Permit <br />Paper Hand ToweU <br />Scap dupenwf <br />Prepare Steve <br />it <br />I <br />TEMP EVENT APPPaaa 8 of 11 <br />x <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />^3 Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Siemo w/Crafflnj <br />Dun <br />5Gil Hand wain <br />Woitowaier Contairw <br />Garbage <br />Can <br />Sanitizer puoet bleacr & water tor <br />storing wipmg dotni <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <br />EHD 16-02 <br />11/4/14 <br />(3 Detergent, bleach, and wiping cloths (cleaning towels). <br />Test strips Io measure sanitation levels for bleach solution measuring WOppm. <br />^Tub to store wiping cloths in bleach solution measuring lOOppm. <br />□ Ice chests <br />Q Refrigerated truck <br />□ Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />© Three compartment sink. <br />Q 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 />Er tn ice Begs i Food Containers must oo <br />stond a mates on of rt>e ground' <br />Extra <br />Wauir <br />ions to be present in booth during all hours of operation: <br />Q <br />“7 <br />Ice Cooler <br />[^Refrigerator <br />□ Ice bath and tubs <br />A----- <br />aaacr and WatarSoao and Water RmM WiMer <br />I Propane Tank <br />I Cutting Board <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 /> <br /> <br />Signature Title <br />$-20 Gai <br />r- hand wasn Water <br />Name^of^sponsible^efsons to <br />E/ang-jiher |