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control for the cold holding of potentially hazardous foods below <br />10. <br />11. <br />OR <br />12. <br />13. <br />’’Important <br /> <br /> DateCompleted by:14. <br />Paper Hana Towels1Soap dispenser <br />Cutung Boaro <br />Bleach <br />Propane Stove <br />\[J <br />Propane T anK <br />Fire Extinguisher <br />1 Ice Cooler <br />TEMP EVENT APP <br />Page 8 of 11 <br />E'nD 16-02 <br />7728/10 <br />Stemo w/Chaffing <br />Dish <br /> Refrigerator <br />Q Ice bath and tubs <br />Extra <br />Water <br />Sanitizer Ducket­ <br />bleach a water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp <br />^Ice chests <br /> Refrigerated truck <br /> Other (specify) <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />rs of operation: <br />my booth for the sanitary cleaning of food preparation utensils: <br />5Rinse Water <br />EZ <br />Soap and Water <br />' ring all hours <br />Lu- <br />Garbage <br />Can <br />1 TdWfood9 Tus" w 4rF <br />' ~ i. Please make a copy of this appIication <br />A copy of this checklist must be i . <br />. Return c..-,—-----------------— <br />of <br />this event. <br />in bleach solution. <br />adequate hand washing facilities, but separate from utensil wash within my <br />Health Permit R <br />Extra tee Sags 4 Food Conta/ners musl be It <br />stored 6 inches off of the ground! » <br />I am providing the following items within <br /> Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum) one for soapy water, one for rinsing and one for a bleac <br />£lution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths <br />I am providing the following for <br />booth: . <br />□ ....... ...........—• •—’“■F M0 ” <br /> one separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Wl Paper towels and pump-style soap container. <br />Names of responsible persons to be