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Mar. 4. 20 1 6 12:56 PM GHI RARDELL I No. 2854 P. 21 <br />10. <br />11. <br />OR <br />□ Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />12. <br />13.present in booth during all hours of operation: <br />14.Completed by: <br />Signature Titla Date <br />Health Permit <br />Paper Hand <br />6qgp dispen&er <br />CutlirK} Board <br />Props'-^ stxxre <br />Propane rank <br />Soap and Waltc-Rlnso Wplsr Bleach and Water <br />f Extra \ <br />( Water | <br />Fl/e Extingiiiher <br />C Inches oft of (he ground! <br />Page 8 oTH TEMP EVENT APP <br />Received Time Mar. 4. 2016 1 2:50PM No. 0539 <br />SZ'- <br />END 16-02 <br />11/4/14 <br />□ Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />0^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />B'f'aper towels and pump-style soap container. <br />O Refrigerator <br />□ Ice bath and tubs <br />5 Gsl Harid waoh <br />Wastewater Contirnar <br />Garbage <br />Can <br />SsniCterbodw- <br />tueacn t; water for <br />elonnj Mplnfl dotbo <br /> Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />E-teS^hests <br />□ Refrigerated truck <br />□ Other (specify) <br />Sterno wAGhefflng <br />Dish <br />Names of responsible Pywjq. <br />’’Important** <br />Ice Cooler I i <br />; . ^xlr^ ic9 BjfQS & Food Canifiinccs cnvsl bo 4? <br />sior^f C Inches oft of the ground! ij <br />6.20 Gd, <br />r* Wcrdwwh 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 />□ 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 />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 gveritt . . <br />/ j A_ i/ri y //^ <br />Tif!n 'Hain