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10. <br />I am providing the following items within my booth for warewashing:11. <br />OR <br />12. <br />13. <br />Names of responsible persons to be present in booth during all hours of operation:U. <br />“Important' <br />Completed by:15. <br />I Paper Hand Towels <br />Cutting Board <br />Propane Stove <br />Propane Tank <br />Blaacti and WaterSoap and Water <br />Fme Erhngutsher <br />TEMP EVENT APRPage 8 o* 11EHD 16-02 <br />7/14/15 <br />Sterne w/Chaffing <br />Extra <br />Water <br />5 Gai Hand wash <br />Wastewater Contaner <br />5-20 Gai <br />Nana wash Water <br />Booth must be on <br />Concrete. Asphah. <br />Plywood, or a Tarp <br />/ <br />■ Ice Cooler <br />\L <br />\ <br />\ <br />Sanitizer bucXet- <br />Weach a water for <br />storing wiping dothsp <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 41T temperature): <br />l^^ce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />(J Ice bath and tubs <br />Date <br />□ Three compartment sink. <br />0 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 />frvent. <br />iF CtuxjSs <br />Title <br />Garbage <br />Can <br />Extra Ice Bags I Food Conlalnsrs mist t» <br />srwBtf 6 mnes slfot the Qround' <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />^/Detergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth. <br />0 Water supply dispenser with warm water at a minimum of 100' F (i.e 5-20 gallon container with spigot). A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style .soap <br />container. <br />Rinse Water <br />______________J <br />Signature \ <br />Health Permit <br />Al! 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 />thisf/Dp <br />I Soap Oispanser