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Environmental Health Department <br />10. <br />I <br />OR <br />12. <br />O Water supply dispenser with warm water at a minimum uf 100’F (i.e. 5-20 gallon container with spigot). <br />□XOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Claudia Nicolaou-Mike Trotter-Melanie Morrison-Nicole Kinsley <br />"Important** <br />14. Completed by-k^,DateTitle <br />Health Permit <br />Paoer Hand Towels <br />Soap diepenew <br />Cutting Board <br />BleachPropane Stove <br />3Propane Tank <br />Bleach wxl Water <br />Fira Extinguisher <br />Stemow/ChaHfing <br />Dish <br />3 Gal Hand wash <br />Wastewater Container <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 />tpn. Return original to festival coordinator three weeks poor to <br />ure Title Date <br />Extra 4 f<>od bo ■ <br />stored 6 inches off of the g/oundl ■ <br />I <br />Soap and Water <br />/ <br />Rinse Water <br />O XPaper towels and pump-style soap container. <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />SanKzarbucfctf- <br />faloach & water for <br />gforing wiping doth* <br />'QA <br />„ / ,>■ •>! '■.'iiy ‘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 />X Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />X Other (specifyChaffing dish with ice inside <br />—Z <br />Ice Cooter <br />w. a <br />^1 <br />Garbage <br />Can <br />11. lam providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />X 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 />QXDetergent. bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 o^raflon. Return original to festival coordinator three weeks prior to <br />Sigi