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10. <br />11. <br />OR <br />12. <br />N.14. <br />“Important** <br />/L15.Completed by: <br />TitleSignature <br />Health Permit <br />Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />Propane T ank <br />Rinse Water Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APRPage 8 of 11 <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 /> Ice chests <br /> Refrigerated truck <br /> Other (specify) <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 />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt. <br />Plywood, or a Tarp. <br />EHD 16-02 <br />7/14/15 <br />Refrigerator <br /> Ice bath and tubs <br />5-20 Gal. <br />Hand wash Water <br />Extra /ce Bags <5 Pood Containers must be stored 6 Inches off of the ground1 <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />I am providing the following items within my booth for warewashing: <br />Three compartment sink. <br />-.r .r-mnSC U,/ ... ./ ../ <br />Soap and Water <br />Ail 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 />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Sf Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket of basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. <br />l^e^pyespon^bj^e^sons to be present in booth during all hours of operation: <br /> Soap dispenser <br />Bi each