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4. 2016 12:59 PM GHIRARDELLI No. 2854 P. 31 <br />io. <br />11. <br />OR <br />12. <br />'aper towels and pump-style soap container. <br />13. <br />14. <br />Date <br />~]Papar Hand TO'.'^b <br />Bleach <br />p/apsn® ok <br />Bleach and We(«f <br />Pago S oHl TEMP EVENYAPp <br />4. 2016 12:50PM No. 0539 <br />O Refrigerator <br /> Ice bath and tubs <br />extra <br />Gerbag© <br />Can <br />Sanitizer <br />biEflcdftwateffar <br />v4p|jKj doDis <br />Q Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />r <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> Three compartment sink. <br /> Water supply dispenserwith warm water at a minimum of 100°F (i.e, 5-20 gallon container with spigot), <br /> Dnp separata tub (backet or basin) for the collection of rinse/wastewater. <br />Slamo v.'/OiafilrM <br />Dish <br />EHD 16-02 <br />11/4/14 <br />Received Time Mar. <br />l<x Qaffy & t^od Copfdif^rs b« <br />tiorwf c int±K off of Hie gmuridl <br />Title <br />^pap ^s^?tlar. J <br />Ma r. <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 gelion of water). <br /> Detergent, bleach, and wiping cloths (cleaning towsis). <br /> Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br /> Tub to store wiping cloths in bleach solution measuring lOOppm. <br />Boom must be on <br />Concrete. Asphall, <br />Plywood, ora Tarp. <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 /><■$0 <3«. <br />Hand wash Wiler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />L Gi) Hand u-'flth <br />Wtotewe f«r Qwi hinw <br />■ii.. <br />-- ------.-.y | <br />Ice Cooler i 1i <br />. ... <br />Soap endWBlGf <br />Fira EjdnguloMf | <br />| Cmilng Board | <br />Propane B(ovd - <br />Names of iresponsible perserfi^to be present injwith during allrirfiurs of operation: tj) <br /> <br /> <br />^Important1’ All food vendor booths ars subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must ba in (he booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks prior to <br />this event <br />Completed by: <br />'-p ( /Signature <br />[Health Penult p <br />IT <br />| Rfnee Waler