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10. <br />11.I am providing the following items within my booth for warewashing: <br />Q Three compartment sink. <br />OR <br />12.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 />13. I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />14. <br />**j <br />15.Completed by: <br />I <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />Propane Tank <br />Bleaof] and Water <br />Fire Extinguisher <br />Sag? <br />TEMP EVENT APPEHD 16-02 Page 8 of 11 <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches off of Ute ground! <br />Stemo w/Chaffing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />O 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) tor the coSection of nnseJwastewaier. Paper towels and a pump-style soap <br />container. <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 />□ Refrigerator <br />□ Ice bath and tubs <br />Title <br />x -— <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 />Extra <br />Water <br />-QT - ((, <br />DateSignature- <br />Health Permit <br />Soap and Wafer <br />Ice Cooler p] <br />OwO-C.. <br />Names of responsible persons to be present in booth during all hours of operation: <br />VWXr-V jrvs^hf’a___________________________ <br />ktk i/o > ci _______ <br />Important** 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 />S-20 Gal. <br />Hand wash Water <br />. / . ____________/1. >y ...... s <br />Rinse Water