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10. <br />11. <br />OR <br />12. <br />Q'Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />Completed by: 14. <br />Signature <br />I <br />Pap«r Hand Towels <br />Soap dispenser <br />CutUng Board <br />BleachPropane Slovo <br />Propane Tank <br />Bleach and Waler <br />Fire Extlnpuislwr <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 /> 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 utensil wash within my <br />booth: <br />Slemo w/Chafflng <br />Dish <br />5 Gal Hand wash <br />Waslewalar Conlalner <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />Extra <br />Water <br />Sanitizer bucket­ <br />bleach i water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />/ | Extra fee Sags <S Food ContainerjmusMwj <br />Title <br />Soap and Waler Rmsa Water <br />Date <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br />0 Three compartment sink. <br />| Health Permit <br />Names of responsible persons to be present in booth during all hours of operation: <br />[A/VV , (2-U U/l <-C- * J / [-1 5 «r*££ nV / C A | L; 6 v/ , ACP O M 3 / <br />, CHUI 5 J / .TkzAv4 G/ag.Azr/V5 7 F'sAfcCl/2. 4 . K./X uJ{j <br />“Important** 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 />Greotness grows nere. <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 /> Ice chests [Z Refrigerator <br /> Refrigerated truck Ice bath and tubs <br />Q'Other (specify) P- /Z C Z f? ft _________________________________________________________— <br />/ <br />Ice Cooler