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No. 2854016 12:52PM GHIRARDELLI <br />I am providing (he following items within my booth forthe sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />detergent, bleach, and wiping cloths (cleaning towels). <br />Test strips to measure sanitation levels forbleach solution measuring lOOppm. <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />Paper towels and pump-style soap container. <br />Completed by: <br />Signature <br />lealth Permit |s <br />P^per l-fcntl TowelB <br />CxjllInQ Based <br />Bieatfi <br />u <br />Fire foaiftQdcbar <br />Pegr 8 of 11 <br />Mar. 4. 20 1 6 1 2:50PM No. 0539me <br />H Ice chests <br />[~~| Refrigerated truck <br />P Other (specify) <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />□ Water supply dispenser with warm water at a minimum of 100°F (l.e, 5-20 gallon container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewaten <br />I <br />6 GqI Hand v/a«h <br />Wastev-'Blw GgnlalnBr <br />5-20 G«. <br />Hand whbTi vVaw <br />Garbage <br />Can <br />Sa/ilfliter bucket* <br />bl aabh & Water for <br />slartng wiping <br />Booth must be on <br />Concrete, Asphalt <br />Plywood, or a Tarp. <br />a-02 <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />Ice B8$5 & Foo^ ConlilPCrt vucl <br />sJoisd F Inches otiariheafvuniJl <br />SteiTK) wJChafflng <br />Dish <br />Title <br />J <br />TEMP EVENT APP <br />^L. <br />Soap and WfiLOT <br />Sft_____ _ <br />fitnae Water <br />O 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 />**1mportarrt** <br />9^-!u <br />Date <br />Cooler | t <br />am providing th© 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 />Soap dlscensar | - <br />AH food vendor booths are subject to inspection. Please make a copy of (his 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 />thip^ent. <br />Bleach ana Waiw I j <br />Names of responsible persons to be present in booth during all hours of operation: <br />E?j <br />P-T-.