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4. 2016 12:57PM GHIRARDELLI No. 2 854 P. 23 <br />10. <br />11. <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 100ppm. <br />12. <br />[x1 Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Signature Title Date <br />r <br />Paper Hand Towels <br />Soap dlapenser <br />Culling Board <br />BIbicHiPropene Slav© <br />1 <br />Propane Tank <br />Fir© Extinguisher <br />stored 6 Inch^ off cf the ground! <br />Page 8 of 11 TEMP EVENT APR <br />[x Ice chests <br /> Refrigerated truck <br />EJ Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> Three compartment sink. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 41 °F temperature): <br />Q Refrigerator <br />Q Ice bath and tubs <br />Extra <br />Waler <br />Garbage <br />Can <br /> Water supply dispenser with warm water at a minimum of 100T (i.e. 5-20 gallon container with spigot). <br />ED One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Names of responsible persons to be present in booth during all hours of operation: <br />Jen Mlssakian <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 event, <br />Stemo wAChaHing <br />Dteh <br />5 Gel Hand wash <br />WfiSlSWaler Container <br />5.20 Gat <br />Hand wash Waler <br />Sanl liter buckeU <br />bleach & waler far <br />Storing wiping cfolhs <br />___ <br />Rlnss Waler <br />END 16-02 <br />11/4/14 <br />Received Time Mar. 4. 20 1 6 12:50 PM No. 0539 <br />OR <br />t 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 />Ey-tre toe Sop? 4 Food Containers must be <br />stored 8 Inches off cl th© ground! »: <br />•‘Important** <br />'J <br />Ice Cooler | ’ <br />Mar. <br />r —— <br />Booth must ba on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />P Health Permit <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Soap and Waler