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11. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Title <br />Paper Hana rc.ve.r. <br />A u <br />Rinse Wafer <br />Ice Cooler <br />■.Tfrlfrl <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />Siemo wrZChatfmg <br />Dish <br />Sanitizer buc'xct- <br />bleach X water for <br />storing wp.ng c'oths <br />S.20 Gai <br />I innci wash Water <br />I Kvtrtt tc<‘ n.-ujft A r-tit <br />HlQfVd 6 iftchus off ft <br />operation. Return original to festival coordinator three weeks prior to this <br />r / <br />title <br />•mo Cnnininfi s ntrtxi im <br />t>f fho wound1 <br />:> Gal Hana wash <br />Wastewater Container <br />Important** All food vendor booths are subject to inspection. Please make a copy of this application <br />in preparation for this event. A copy of this checklist must be in the booth at all hours of preparation and <br />'. ix <br />Garbage <br />Can <br />| Propane lonk <br />Date <br />(= <br />T~ <br />| Soap nnd Wntor | <br />Fire Extinguisher <br />1 I Bleach on fl Water <br />--- ----------------- . <br />Health Permit <br />15. Completed by: vL/J/Z/C <br />Signature <br />Note: Examples of potentially hazardous food incmae: meats, tamaies, coosea Deans, l ive vegetauwa, <br />potato salad, eggs and dairy products, fj <br />10. lam providing the following cold temperature control for the cold holding of potentially hazardous <br />foods below 45 degrees Fahrenheit (if food is used the following day, maintain below 41 degrees Fahrenheit): <br />[ ] Ice chests [ ] Refrigerator [ ] Refrigerated truck <br />[ ] Ice bath and tubs [ ] Other (specify): __________________ <br />I am providing the following items within my booth for ware washing: <br />[ ] Three compartment sink <br />OR <br />[ (0 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 />[^3 Detergent, bleach, and wiping cloths (cleaning towels). <br />[ffl Tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation <br />I Cutting Do.wd | <br />Prepane State _ <br />12. lam providing the following items within my booth for the sanitary cleaning of food preparation <br />utensils: <br />Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within <br />my booth: <br />gtS Water supply dispenser with warm water at a minimum of 100 degrees Fahrenheit (i.e. 5-20 gallon <br />container with spigot). A separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels <br />and a pump-style soap container. <br />14. <br />Extra <br />Wafer