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10. <br />11. <br />OR <br />12. <br />13. <br />Important** <br />Completed by: 14. <br />Health Permit <br />Paper Hand T oweU <br />Scac dHpenwr <br />]Cutting Board <br />Prcpana Stove <br />it <br />Fee Ejding'a't'er <br />Ice Cooler <br />TEMP EVENT AFPPa^e 8 of 11 <br />\ <br />aeeo- and WWer <br />EHD 18-02 <br />11/4/14 <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 410F temperature): <br />Eftn toe Bags 4 Food Contunea matt <br />stored 8 mcnes off or trie grnuncr <br />Slemo w/Cnattlng <br />&»n <br />□ Refrigerator <br />□ Ice bath and tubs <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />Extra <br />Watar <br />SGal Hand warn <br />Waslewatar Container <br />5-20 Gai <br />Hand wastt Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp <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 />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Sanituar Buoet <br />btoacti I wb« tor <br />stonng wipng doeis <br />(^flce 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 />^’fhreeicDmp^rtrnent^ink?^ <br />116 <br />Date <br />—? <br />Soap aodWrar <br />r <br />Ri rm Water <br />Title' <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event, <br />preparation and operation. <br />this event, <br /> <br />Signature <br />I Propane Ta-w <br />H 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 />0 Detergent, bleach, and wiping cloths (cleaning towels). <br />0 Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />(ZfTub to store wiping cloths in bleach solution measuring 100ppm. <br />Names af responsible persons to be present in booth during all hours of operation: