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P. 5No. 392 1Oct. 16. 20 1 5 12:09PM <br />idP <br />I am providing [he following items within my booth for the sanitary cleaning of food preparation utensils; <br />□ Three compartment sink. <br />OR <br />□ Tub to store wiping cloths in bleach solution. <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />43? Na <br />Completed by: <br />Health Permit <br />Paper Haod Toz/els <br />Swap dispenser <br />Cutting Board <br />Bl6E>cnPropane Stove <br />5? <br />Propene Tank <br />BI&acTi and WaterSoap end Water Rinse Water <br />Fire Extinguisher <br />Ice Cooler <br />Pags 8 of 11 TEMP EVENT APP <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Slemo w/Chaffing <br />Dish <br />Extra <br />Water <br />5 Gel Hand wash <br />Wsslewal&r Container <br />&2O Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Boolh must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <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 />□ Refrigerator <br />□ ice bath and tubs <br />SantoefbuckEt- <br />bteach & waler Ax <br />storing wiping cloths <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Q^Paper towels and pump-style soap container. <br />oiiJNir <br />Title <br />EHD 16-02 <br />Received Time Oct. 16. 2015 12:22PM No. 9807 <br />Date <br />’"'Important''* <br />.11.’ <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 41T temperature); <br />^flce chests <br />O Refrigerated truck <br />□ Other (specify) <br /><1:2? <br />sArert/ C Inches off of (he ground I ■ <br />.rn^ of responsible p^rsoys tc^e pr^senHn^oth during^ll^roure pfo^ratiop^^^^ -p <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 />T 7 Signature