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10. <br />11.I am providing the following items within my booth for warewashing: <br />□ Three compartment sink. <br />OR <br />12. <br />13. <br />14. <br />•‘Important** <br />loJ/d//G <br />Date <br />15. <br />late <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Slova <br />I <br />Propane Tank <br />Soep and Water Bleach end Water <br />Fire Extinguisher <br />Page 8 cf 11 TEMP EVENT APPEHD 16-02 <br />7/14/15 <br />13 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45UF (if food is used the following day, maintain below 41 °F temperature): <br />Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Waler <br />Garbage <br />Can <br />Sanitizer buckot- <br />bloach & water for <br />staring wiping dolhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chatfmg <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal <br />Hand wash Water <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 items within my booth for the sanitary cleaning of food preparation utensils: <br />J^Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />Rinse Water <br />Extra Ice Bags & Food Containers must be K <br />stored 6 incnes oft oi the ground'. i i <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Water supply dispenser with warm water at a minimum of 100°F (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. <br />Names of responsible persons to be present in booth during all hours of operation: <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 />Completed by: //fey-,C(_) f\J r a*ur' Tlt|e <br />Cutting 3oara