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10. <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 />water, one for rinsing and one for a bleach <br />□ Detergent, bleach, and wiping cloths (cleaning t< <br />□ Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />12. <br />□ One separate tub (bucket or basin) for the collection of rinse/wastewater. <br />□ Paper towels and pump-style soap container. <br />13. <br />Title J <br />14.Completed by: <br />Itjnature <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />BleachPropane Stove <br />u <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />Soap and Water <br />EHD 16-02 <br />11/4/14 <br />I am providing the following for adequate <br />booth: <br />S Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <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 />Sterno w/ChaffingDish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />□ Three deep tubs (basins 6-8 inches minirhi <br />solution (one tablespoon of bleach per gallon of <br />5-20 Gal. <br />Hand wash Water <br />Names of responsible persons to be present in booth during all hours of operation: <br />------------------------------------------------------------------------ <br />Date <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <br />hancT'vyashing facijiiie&rbut separate from utensil wash within my <br />□ Water supply dispenser with warm water at a rrmimum of 100°F (i.e. 5-20 gallon container with spigot). <br />Rinse Water <br />“Important** <br />------ -----------------1 <br />Health Permit P <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 />Extra Ice Bags & Food Containers must be I <br />stored 6 inches off of the ground!