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10. <br />11. <br />OR <br />Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution <br />12. <br />13. <br />14.7 <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />'I <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 />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 />Stemo w/Chaffing <br />Dish <br />Sanitizer buckel- <br />Dleach & waler tor <br />storing wiping cloths <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Jz’frhree compartment sink. <br />□ Ice chests <br />0^Refrigerated truck <br />□ Other (specify) <br />TZfRefrigerator <br />□ Ice bath and tubs <br />5-20 Gal <br />Hand wash Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />PTWater 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 />Booth must be on <br />Concrete, Asphalt <br />Jlyw. -.ra Tarp. <br />J\T-, <br />Title <br />_____ <br />Health Permit <br />■ r* ah“Important <br />Date <br />pTPaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />>d 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:C|A,[ <br />Signature