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Mar. 4. 2016 12:51PM GHIRARDELLI No, 2854 P. 7 <br />10. <br />11.v/n- <br />OR <br />12. <br />13. <br /> <br />^Important” <br />14.Completed by: <br />Health Permit <br />Paper Wand Towels <br />Soap dispenser <br />Culling Board <br />Propane Stove Bleach <br />Propane Tank <br />Rinse Wgier Bleach and Wniar <br />Ice Cooler i <br />Pace 8 of 11 TEMP EVENT APP <br />IBM <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Test strips to measure sanitation levels for bleach solution measuring 10Oppm <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />Exlm /eg (tegs S Food Containers musi t)9 <br />stored $ incnas off of (he groundl ‘ <br />5 Gal Hand w^sh <br />Wistowatgr ConlGiper <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & waior for <br />slcring wiping cJolhs <br />Boolti must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Q Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Slemo w/ChafTing <br />Dish <br />□ Refrigerator <br />□ ice bath and tubs <br />Exira <br />Waler <br />6-20 Gal. <br />Hana wash Waler <br />z<’ <br />AA. <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 /> <br />Signature <br />EHD 16-02 --------------------------------------------------------------- <br />IIM/14 <br />Received Time Mar. 4. 2016 12:50 PM No. 0539 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils; <br />Q Three compartment sink <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within mv <br />booth: <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 />| Fire Extinguisher <br />Title Date <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 />(E^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Q^One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />^LPaper towels and pump-style soap container. <br />t0 be pre£erit in booth durin9 al1 hours of operation: <br />Soap and Wafgr I