Laserfiche WebLink
t <br />•10. <br />11. <br />□ Three compartment sink. <br />OR <br />12.I am providi <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />15.Completed by: <br />Date <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Bleach and Water <br />Fire ExtinguisherQ <br />Ice Cooler <br />TEMP EVENT APP <br />7 <br />Soap and Water Rinse Water <br />EHD 16-02 <br />7/14/15 <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 />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 />□ tCe chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Stemo w/Chaffmg <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach 8 water lor <br />storing wiping cloths <br /> Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp <br />Extra <br />Water <br />5-20 Gal. <br />Hand wash Water <br />Title <br />'Cl rh <br />Extra Ice Bags & Food Containers must be Q <br /> stored 6 inches oft ot the ground1 I <br />•‘Important** <br />I am providing.the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />□ Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soap <br />container. / A- <br />Names of responsible personsto be present in booth during all hours of operation: <br />rrJele or <br />Page 8 of 11 <br />I am providing the following items within my booth for warewashing: , / <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