Laserfiche WebLink
10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />OR <br />D Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />0 Water supply dispenser with warm water at a minimum of 100oF (i.e. 5-20 gallon container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />0 Paper towels and pump-style soap container. <br />13. <br />Date <br />14. <br />Title <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />BleachPropane Stove <br />Propane Tank <br />4 <br />Bleach and WaterRinse Water <br />■■ <br />TEMP EVENT APPPage 6 of 11 <br />Completed by: fAnVyvmpJ SouE'gifVL. <br />Signature <br />EHO 16-02 <br />08/0V16 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45OF (if food is used the following day, maintain below 41 °F temperature): <br />0 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 for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />Sterno w/Chaffing <br />Dish <br />□ Refrigerator <br />O Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Contawier <br />Garbage <br />Can <br />Sanffizer bucket­ <br />bleach & water for <br />storing wiping dolhs <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />0 Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />1 <br />i.'» <br />|__Cultinfl Board <br />Names of responsible persons to be present in booth during all hours of operation: <br />sSotiFiPnP 7 rit Vi erf_________________________________________ <br />/V'l rohrt.ynPrtl Al.t ________________________________________________________________________________ <br />**lmportant** 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. Rgtum original to festival coordinator three weeks prior to <br />this event. <br />Extra Ice Bags & Food Containers must be || <br />stored 6 inches off of the groundl p <br />! 5-20 Gal <br />Hand wash Water <br />I I I -1I I Soap and Waler <br />I I Fire Extinquisher I <br />Ice Cooler