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a'ly hazardous foods below10. <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 />'j/Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />(iZTub to store -wiping cloths in bleach solution measuring 100ppm. <br />12. <br />13.Names of resp/nsibi iresent in booth during al! hours of operation:persons bofc. <br />14.Completed by:2 <br />Signature Title <br />| Health Permit <br />Soap pispanser <br />Cutting Boat d a BleachPropane Stove <br />3 u <br />Propane Tank <br />-)Soap and Water = each and Water Garbage <br />Fire Extinguishor <br />(- <br />) <br />Pago 5 of 11 TEMP EVENT APP <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />Sanitizer bucket' <br />olesoh & water for <br />stonng wiping cloths <br />Booth must be on <br />Concrete. Asphalt, <br />Plyv/ood, or a Tarp <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <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) <br />Ijybetergent, bleach, and wiping cloths (cleaning towels). <br />Steno w/Chaffino <br />Dish <br />EHD 16-02 <br />11/4/14 <br />5-20 Gel <br />Hana wash Wa'ar <br />Extra <br />Water <br />Paper Hand Towels | <br />Ice Cooler 1 : 1 -- --------- <br />Extra Ice Bags & Food Containers must be <br />.---------------------------------- stored C inches oft of ths ground' <br />‘"Important"' <br />LuX^ater supply dispenser with warm water at a minimum of 100”F (i.e. 5-20 gallon container with spigot). <br />5^6ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />l^/p'aper' towels and pump-style scao container. <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 evfrit. 4 . / <br />Title Date <br />Rinse Water <br />I am providing the following c smperature control for the cold holding of pot <br />45'F (if food is used the following day, maintain below 41 °F temperature): <br />E^foe chests <br />rj Refrigerated truck <br />□ Other (specify)