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1C <br />03 <br />X Oetergent, bieech and wip -g cloths (cleaning tov.-a s <br />'3 <br />’’Important” <br />Completed by: <br />■Signature Date <br />Health Permit <br />I SKczvrw <br />B <br />.1-tc:ar»s '-^ik <br />6 m* ns ■•.•s.c <br />~n <br />P»3e • of 11 *EV’EV£\? ASP <br />■ <br />I <br />\1j—t <br />J I <br />1=2 Cu~StS <br />•~'l Re'hcerated fuck <br />_7 Ct’-e'isrecfp__ <br />5G*K«-Sw*sn <br />WSKc-ttet Csrtalisr <br />Cartage <br />Cao <br />Boctn mu« be on <br />Cc-erete. AsptaK. <br />Ptyv/ood. or a Tarp. <br />s-z> GW <br />:iwc *ur <br />Sinurtfeckv- <br />UMllTS ~wt <br />E-.C icj:? <br />Refr gerstor <br />~ :ce beth and tubs <br />Na es of responsible oersons to be present in booth during al! hours of operation: <br />------------— \ errr>n fry nr. <br />Hu <br />/ <br />^ritViXat <br />% Water supply disperser wth iv=rm water at 3 minimum of 10DT (i.e. 5-20 gallon container vZth spigot; <br />C-= separate ‘.jo (bucket or bas:n) forthe co iectio- of rnse/y.'astevvater. <br />P? Paoer to?.els and pump-st/e soap container <br />: 4! <br />Ice Cooler 1 t ------- ----------- <br />£*»-•4 Fa;2 Cv'it^rt r-^it »♦ <br />" t atr c: pzvr.a' <br />followin9 f’°r adequate hand wash.rg fac ines b.t sepa-ate fpm uters i wash within my <br />X I’sst st':os to measure sanitation 'eve’s for bleacr solution measuring lOOppm <br />■ ub to s'.cre wiping o'oths in bleach solution measuring WCppm <br />J:a>e <br />if-ee deep lues (basins 5-3 nches minimum.) one fo’ soapy water, one fo' r.r.s ng and one for a e'ea-h <br />so j* on (ore tablespoon cf b’eac.h per gallon of water) <br />‘ "9.tbe b:,o‘VinS cz'd ‘‘emcerature centre: fo: the cold ho ding cf ootentiaily hazardous foods ce'cw <br />F ' CC3 's used th.e fa owing day, ma ntain beicwdf-F tempemturec <br />=71 <br />7 <br />5:k <br />jUryr- <br />TitJe <br />A.i food ve’der booths are subject to inspection Please make a copy of this application ;n <br />preparation -pr this event A copy cf 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 />I S:c—j-C"*--’? <br />>n <br />I am pro; o -g (he following items witn.n my booth hr the sanitary cleaning of food prepa’abon utersi s <br />__Tnree ccmca-.'rent sink