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4. 2016 12:55PM GHIRARDELLI No. 2854 P. 19 <br />io. <br />it <br />OR. <br />12. <br />13. <br />14.Completed b/ <br />Health Permit <br />Papor Hand Tweta <br />Soqp tfiacorttfl- 1 <br />Propane Stow <br />u I <br />BteaohandWztfef <br />fire ExSngtfBher <br />Pay© fl of 15 TEMP EVENT APP <br />Received Time Mar. 4. 20 1 6 1 2:50 PM No. 0539 <br /> <br />EHD 16-02 <br />11/4/14 <br />□ Ice chests <br />O Refrigerated true <br />O Other (specify)_ <br />8 tamo wJChaffirw <br />□ Refrigerator <br />Q Ice bath and tubs <br />6-20 GA <br />wiasft water <br />eanKfear Ducfcat- <br />OJaacfiGWaterfor <br />staing Mping dcrtTa <br /> Booth must be on <br />Concrete, Asphoff, <br />P^wod. or a Tarp. <br />5 GaJ RerwJ u®8h <br />WdSlfiwatw- COT^sinef <br />^nature <br />ft"' <br />(Loo. <br />Title <br />event. A copy of this checklist must be in the booth at all hours of <br />'ration. Return original to festival coordinator three weeks prior to <br />propens Tin* <br />^TLdb <br />Date <br />aifiSsSgSssc' <br />C " <br />Garbage <br />Can <br />Mar. <br />All food vendor booths are subject to Inspection. Please make a copy of this application in <br />preparation for tj-’- - r ...... . ... <br />preparation ai <br />thfeeveBt. <br />1 the fol,owfn9 “W temperature control for the cold holding of potentially hazardous foods below <br />45 F (rf food is used the following day, maintain below 41 °F temperature): <br />iog BtfffS &.FQQtfGQaQio&fsnTust 69 I § <br />sfryad G foobBS offoftha gmood! I £ <br />^fone separate tub (bucket or basin) for the collection of rinse/wastawaten <br />J^fpaper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation- <br />4jMkiA—__.. <br />**Important*42x <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />Vf 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 />^Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />□ Tub to store wiping cloths in bleach solution measuring 10Oppm. <br />bSih^^^'H9 fol,OWin9 f°r adet’uate hand washing facilities, but separate from utensil wash within my <br />^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Ice Cooler ? <br />I Soap and Wnw RfrissV\^W I <br />I CufingBoACd