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#5/703-07-19;04:29PM; <br />8. <br /> <br />fl. <br />OR <br />10. <br />O-bIvI? W8P container. <br />13. <br />"ImportanV* <br />14.Completed by: <br />Health Permit <br />FXHrvToam <br />1 5£' <■ <br />aMArtMtar <br />Ice Cooler i <br />FMoeflcrffl T8MPEVEMT A/*P <br />I<11)1 <br />SamiaffitAM. DWilWWltf <br />EHD1MKZ <br />KkliAW <br />Ttanj»Q»ftnQ <br />EKh <br />□ Refrigerator <br />Q Ice bath end tuba <br />AC^Mmdwam <br />ii CPnUvw <br />&2DGM <br />ManJ mm Mair <br />Booth muil be on <br />Coeermo, AipheJt, <br />Pb-wood. or a Tarp.I <br />e*9t9BlQt <br />| 8«w Jana | _____ <br />Gertwoe <br />On <br />GEI^odieu. <br />0R®frioetated truck <br />□ Other (Bpedfy). <br />S1^^n^hil^^S^i6ltinCh*S l7',ll'LUm)' one watef- 0,16 1or r>1ainfl and one 'or a bleach <br />soliwn (one teblespoon of bleach per gallon of water). <br />UZDetergent, Beach, end wiping doths (deanlng towels). <br />□ Ttfj to atone wiping cloths In bleach solution. <br />f <br />I r <br />*»■ DV^Mnar ' I <br />[0 Three compartment elnk. <br />NamM of responsible persons to be <br />___ ^r/^tnarO <br />All food vendor booths are subject to Inspection. Please make a copy of this appicstton h <br />preparation for this event A copy of this checklist must be In tho booth at an hours of <br />Bdsm^nt and 0peraUon' ^gtMrn ortfllnal to festfvitl CTordlnafor three visits prior to <br /> <br />Signature Title Date <br />J <br />r»mw | r <br />A <br />l^em providing the following for adequate hand washing fadliUes, but separate from utensil wash within my <br />k/wator supply dispenser with warm water at a minimum of 1 QO’F (l.e. 5-20 gallon container with spigot), <br />[gpne separate tub (bucket or basin) for the collection of rinseAvastewatar. <br />0 Paper towels and <br />Ja booth during all hours of operation: <br />(g-<r)6t __