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, <br />Health Permit <br />EH) 10.02 <br />D8/01/10 <br />Page 8 of 11 TEMP EVENT APP <br />Steno w/Cheffing <br />Dish <br />640 Gal. <br />Hand wash Watet <br />Paper Hand 'Towels <br />Sanitize: bucket - <br />bleach & water for <br />storing wip)ng cloths <br />Cu ling Board <br />Soap dispenser <br />Propane Stove Bleach <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />At'l <br />9oap and Water <br />Fire Extinguisher <br />Garbage <br />Can <br />Propane Tank <br />Extra <br />Water <br />Ice Cooler <br />Extra ice 0e9s Food Containers must be <br />stored 1 Inchos o(( o/ The ground? <br />8 Gal Hand wash <br />Wastewater Container <br />Rinse Water Bleach and Water <br />Dutig.4 f itf <br />Title <br />5/9/24 <br />Date <br />DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />'10. ' lam 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 />xi ice chests 0 Refrigerator <br />0 Refrigerated truck 0 ice bath and tubs <br />El Other (specify) <br /> <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 />O 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 />O Detergent, bleach, and wiping cloths (cleaning towels), <br />El Tub to store wiping cloths In bleach solution, <br />12, I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth; <br />Water supply dispenser with warm water at a minimum of 100°F (i.e, 5-20 gallon container with spigot). <br />Ej One separate tub (bucket or basin) for the colleotIon of rinse/wastewater, <br />IN Paper towels and pump-style soap container. <br /> <br />13. Names of responsible persons to be preient in booth during all hours of operation; <br />r 004 litt•c,“7 e' I Pc 4,e-Ar <br />"Important** All food vendor bodths are subject to inspection. Please mike 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 oriulnal to festival coordinator three weeks prior to <br />this event, <br />14. Completed by: 1.3-4(ej-K/ <br />Slaature