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10. I art providing the following cold temperature control for the cold bolding of potentially hazardous foods <br /> below 45 degrees Fahrenheit(if food is used the following day, maintain below 41 degrees Fahrenheit): <br /> [�] Ice cysts Pq Refrigerator [ ) R.efrigereted truck <br /> Ice bath and tubs [ I Other(specify): <br /> 11. I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br /> [ j Three compartment sink <br /> OR <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 ofbleacb per gallon of water). <br /> pj Detergent,bleach,and wiping cloths(cleaning towels). <br /> [ Tub to stone 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 /> M Water supply dispenser with warm water at a minimum of 100 degrees Fahrenheit(i.e. 5-20 gallon <br /> container with spigot). <br /> pC] One separate tub(bucket or basin)for the collection of <br /> [ Paper towels and uumR--s#vl�container. <br /> 13. Names nsib pqrsps to be present in booth during all hours of operation: <br /> **Important''* All food vendor booths are subject to inspection. Please make a copy of this application <br /> in preparation for this event. A copy of this checklist must be in the booth at all hours of <br /> preparation and operatiom jMrn or'orWW to kstl W coordinatQr three weeks prig <br /> to this evenm <br /> 14. Completed by: � "'`'" <br /> /21Y <br /> Signature Title Date <br /> ► eWth <br /> +,.....n.. al..w w.ra-W�* <br /> Boom M be an <br /> Oonomla,MphW <br /> Plywood w-Tom <br /> •.erla taw <br /> faw►awl�l �r lti1aF' ��ai w� ��� <br /> Can <br /> Era <br /> Ice <br /> j( Waar <br /> Comer a l al NO""waM <br /> Caw rw/rM�!'Ya/GWIYrtrf.lr�t�a W�rMOerWw <br /> "M 3f#3 'TEMP xvM Am <br /> #71=9 <br />