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10. <br />11. <br />OH <br />□ Detergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />krTWatcr supply dispenser with warm water at a minimum of 100 I (i.c. b-20 gallon container with spigot). <br />13. <br />14. <br />Date <br />Health Permit <br />1:;. I ■! «k! . <br />SO.’ip <br />BIhiu n <br />l i.il.'.ini' Slow <br />0n <br />I,ink <br />i .ri'i W itot <br />TFMPFVFNT APPPage 8 of 11 <br />Z <br />Ice Cooler <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Q^Three compartment sink. <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 />Cxfr.i Ice (Idfis & I'octl Conl.^it~ r, nwi l>e <br />stall’d <3 eti hi-- ott o' tee fgixira/' <br />I. G<il Iv.'i >'< <br />. i ... '■ . '' • <br />Garbage <br />Can <br />' .I'lHi/'it ixx kH <br />tjk’.u it wilvi lot <br />I <.Hh ■ <br />Brxith must bo on <br />Concrete. Asphalt <br />Plywood, or a Taip <br />□ 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 />Names of responsible persons to be present in booth during all hours of operation: <br />/Agryh <br />Ef Refrigerator <br />□ Ice bath and tubs <br />Stcino wOtiilliiKt <br />Dfah <br />EHD 16 O? <br />no tn I i A <br />& .’G Gul <br />ll.i Kt .. r.’iW.ifM <br />( ! ■' \ <br />Wut<-» I <br />Title <br />__d <br />Soap ti'Kl Will.* <br />El One separate tub (bucket or basin) for the collection of rinse/wastewator. <br />0 Paper towels and pump-stylo soap container. <br />‘’Important*’ <br />I Fitil FxIl’KIUiMlH fl'T <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 bo in the booth at all hours of <br />preparation and operation Return original to festival coordinator three weeks prior to <br />this event. / <br />Completed by: <br />U ^Signature