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10.Ily hazardous foods below <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Fl Three compartment sink. <br />OR <br />O Detergent, bleach, and wiping cloths (cleaning towels). <br />U Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />□ Tub to store wiping cloths in bleach solution measuring 100ppm. <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 soap container. <br />13.Names of responsive persons to be present'oth during all hours of operation: <br />T* i I rs ' + <br />14.Completed by; <br />Signature Title Date' <br />Paper Hand Towels <br />BleachPropane Stove <br />u r <br />Propane Tank <br />Soap and Water Breach and Water <br />Fire Extinguisher <br />' Ice Cooler I i <br />Pago 5 of 11 TEMP EVENT APP <br />Rinse Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />□ Three deep tubs (basins 5-3 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 />□ Ice chests <br />O Refrigerated truck <br />□ Other (specify) <br />Extra ice Bugs & Fosd Containers must be <br />stored S inches off off be ground' <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 />Steno w/Chaffing <br />Dish <br />□ Refrigerator <br />Q Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-2D Gal <br />Hand wash Water <br />Garbage <br />Can <br />Sanllizer bucket- <br />bleach & water far <br />storing wiping cloths <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp. <br />EHD 16-02 <br />11/4Z14 <br />Extra <br />Water <br />‘'Important** <br />I am providing the following cc umperature control for the cold holding of pok <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />| Seas cisptnsBr <br />Health Permit U