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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 />F] Detergent, bleach, and wiping cloths (cleaning towels). <br />12. <br />13. <br />lSl14. <br />\ <br />Soos stsponsor <br />SteachPre pane S’ova <br />5-U-0- <br />Propane Tank <br />Rinse Water E'each ana kVSter <br />Ftnj Exanguiincr <br />Water <br />Psge 5 o’ 11 7EM= EVENT APPEHO 16-22 <br />11/4/14 <br />Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />O Tub to store wiping cloths in bleach solution measuring WOppm. <br />□ Refrigerator <br />O Ice bath and tubs <br />Garbage <br />Can <br />Booth must be on <br />Concrete. Asphalt, <br />Plywood, or a Tarp. <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 />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />[2J.lce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />5-23 Gal <br />Hand wEsh Watir <br />Sanlzartxcice:- <br />aicKfi & *rsterfcc <br />siortng widna gjoihs <br />Stems Hr'Chafira <br />□tsh <br />Qv 0 <br />Title <br />5 Gai Hard <br />Wastavifatar Czr.taj.tcr <br />nN <br />Date <br />J <br />Scap snd Wste- <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 pumo-stvle soao container. <br />ejrfre .'ee Bsjs i Fczd Cwfiam^rs tzzisi te <br />stores C inches or o.'*7e <br />•‘Important** <br />Names of responsible persons to be present in booth during all hours of operation: <br />■$oe t (2> cVryAcx^ t t W\(XY\C^_______ <br />ice Cooler ' ' <br />__________j.--‘ <br />Paper Wane Towcis | <br />I am providing the following temperature control for the cold holding of potentially hazardous foods below <br />45CF (if food is used the fo ng day, maintain below 41 °F temperature): <br />23^232^^2^ <br />Health Permit <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 />Completed by: t A t <br />Signature <br />Cult ng Eoad