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1No. 9 78 :P.May. 24. 2016 11:25AM <br />10. <br />providing the following items within my booth for warewashing <br />OR'; <br />12. <br />13. <br />14.Ni <br />15.Completed by <br />Curtt^ Berard <br />& wen L <br />I <br />Tank <br />Pinsfi <br />j ri/TI <br />Ice Cooler <br /> <br />Page 8 of ■ i TEMP EVENT aPP <br />7 / <br />0 Ice chests <br />0 Refrigerated truck <br />□ Other (specify). <br />5-20 <br />Hana wasn <br />Garbage <br />Can <br />EHD 1B-OJ <br />7/1W15 <br />Stems wehaftmj <br />Cssn <br />11 refrigerator <br />Q Ice bath and tubs <br />Bootn must be on <br />Concrete, Asphalt. <br />Plywood, or s Tarp <br />5 Gai Hanc <br />wajaowgter Contandi’ <br />____ | naw' Hsm ’r*sis <br />\ " <br />'----- \ <br />\ <br />Hr/ <br />0 <br />I Sioacn ana W®ter <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils <br />E^Oetergent, bleach, wiping cloths (cleaning towels), ano a tub to store wiping cloths in bleach solution <br />s^KThree compartment sink. <br />I^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 />E.'cri ’ <br />•A'aror | <br />S^Trtixev txjckc.- j <br />i waier few j <br />| aoHnn ^ptnq dorTs. f <br />I em°providing the following cold temperature control for the coid holding of potentially hazardous foods below <br />45°F (if food is used the following day. maintain below 41 °F temperature!: <br />I SoAc di SLm-r.ser <br />QouJU <br />11 <br />----II <br />Propene S»vd <br />j &tr» kz &J9J 4 FtxxJ Cdnfainflrs mus (X <br />sxxW 6 /rtcfvs off or rr>e <br />I am providing the following for adequate hand washing facilities but separate from utensil wash within my booth- <br />fZfwater 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 />(^0 <br />fide <br />11. I <br />Nam^sAf responsible persons to be present in booth duri.no all hours of operation- <br /> __ <br />“Important** 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 onqipat to festival coordinator three weeks prior to <br />this event <br />' v Signature <br />Heatth Permit