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’10. <br />11.J am providing the following items within my booth for warewashing: <br />OR <br />12. <br />13. <br />14. <br />15.Completed by: <br />V <br />Paper Hand Towels <br />Soap dispenser <br />Propane Stove Bleach <br />Propane Tank <br />Kleacti and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 erf 11 TEMP EVENT APP <br />EHD 16-02 <br />7/14/15 <br />Sterne w/Chaffing <br />Dish <br />5 Gai Hand wash <br />Wastewater Container <br />Sanitizer bucket- <br />bleach & water for <br />storing wiping doths <br />' '______________________________________■ <br />Health Permit <br />O Refrigerator <br /> Ice bath and tubs <br />A copy of this checklist must be in the booth at all hours of <br />Return original to festival coordinator three weeks prior to <br />5-20 Gal <br />Hana wash Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, ora Tarp <br />Title <br />_____._________________ <br />Extra ice Bags & Food Containers must be <br />stored 6 inches off of the ground1 <br />Date <br />isi ______J/ <br />Rinse Water <br />“Important** <br />vF FJ I I___T <br />Soap and Water <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 />Names of responsible persons to be present in booth during all hours of operation- <br />_____J— F'cv-’r/ ~~ <br />Al! food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. ‘ <br />preparation and operation <br />this event. <br /> <br />Signature <br /> Three compartment sink. <br />He 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 cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />S ice chests <br /> Refrigerated truck <br /> Other (specify) <br />! Extra <br />Water <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Q 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 />Cutting Board