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PAGE 0307/17/2017 13:29 9136033b..J6 <br />10 <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils;11. <br />’hree compartment sink. <br />OR <br />OOetergent, bleach, and wiping cloths (cleaning towels). <br />□ Tub to store wiping cloths in bleach solution. <br />12. <br />□ 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 gpao container. <br />13. <br />Completed by: 14. <br />Signature Date <br />I <br />Pnpa.- Hana Tow«>S <br />Soup aiwonBac <br />CulbAp Board 3 SlouchPropane $tovo <br />r <br /> ifei <br />Pln>o W«tar Biooch anc Weiw <br />Fl ft) EMiApu'Jt'or <br />Ice Cooler <br />P«VO 8 ofl 1 TEMP EVENT APPEHD 18-02 <br />08/01/16 <br />O Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <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 />Stwrw w/Ch«ffino <br />Oiwi <br />Q^fefrigcrator <br />□ I co bath and tubs <br />Exira <br />Walor <br />Garbage <br />Can <br />5 Gal Hand wash <br />Waaiawaler Contalnar <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sar.ltzefbuckel- <br />blM4h & walor for <br />sto'ir.g wiping doth» <br />Title <br />Soap and WdW <br />Propane Tank <br />’’Important** <br />| Health Permit <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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 />5-20 Oal <br />r- Hana w«Bh Water <br />J---\ <br />Names of responsible persons to be present in booth during all hours of operation: <br />P<?v _________________________________ <br />&(rS lets Bags t. Food Conloiten must tX) K <br />WO-W 6 IrKflOS OH 01 Ite OmMtil ■ <br />Q/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).