Laserfiche WebLink
<br />¥ <br />10. <br />11. <br />bleachfor rinsing and one for aOR <br />utensil wash within my <br />12. <br />13. <br />C • n 'A <br />‘‘Important** <br />'A I 0 7 ~ <br />Signature <br />Completed by: 6?cacVx\( ,|14.3/14/25 _Date <br />Health Permit <br />Paper Hand Toy^is <br />Soap dispenser <br />Cixiinq Board <br />Propane Stove 8 teach <br />Propane Tank <br />Soap and Water Rinse Water Bleach and Water <br />Page8 of 11 <br />TEMP EVENT APP <br />Pre Exiinguisher <br />EHD 16-02 <br />08/01/16 <br />Stemo vr/Chaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5-20 Gal <br />Hatxi wash Water <br />Garbage <br />Can <br />Oarotizer bucket- <br />W<-Jch & wjoer fo<- <br />Sorina wiping cioths <br />Ice Cooler j <br />Title <br />F <br />5 Gal Ha xi wash _____ _ <br />Wastewater <br />Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />! am pmvlding lhe foiling Kerns —a m, booth to, the sanitary cteaning otfood preparation utensils: <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />I am providing the following cold temperature control for4th® ne^atureyf P <br />45T (if food is used the following day, maintain below 41T temperature). <br />Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />^Detergent, 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 <br />booth: <br />Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot) <br />[T] One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />/^IjCirVk) lYVTOVAO 7 — cx\\c\ C <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 operation Return original to festival coordinator three weeks prior to <br />this event <br />6 inc^ te <br />