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10. <br />11. <br />OR <br />12. <br />13. <br />Nai14. <br />Completed by:15.ignature <br />1 Paper Hand Towels <br />Cutting Board <br />Bleach <br />Propane Stove <br />Propane T ank J <br />Fire ExtinguisherAH <br />f <br />Soap and Water <br />3'lce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />□ Refrigerator <br />□’Ice'bath and tubs <br />Extra <br />Water <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Sterno w/Chaffing <br />Dish <br />5-20 Gal <br />Hand wash Water <br />Title U Date <br />sanitary cleaning of food preparation utensils: <br />I am providing the following items within my booth for warewashing: <br />I am providing the following items within my booth for the <br />bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br /> <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 />□ Three compartment sink. <br />OFfuee deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br />Ice Cooler I <br />"Important” <br />Extra Ice Bags 4 Food Containers must be <br />stored 6 inches off of the ground! <br />for soapy water, one for rinsing and one for a bleach <br />Soap dispenser <br />| Health Permit <br />Rinse Water <br />:' - ' T <br />)QSible persons io oe present ni uuuui uu. -i------------- <br />___________ ____________—------------------------------------------------------------- <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 hoursi of <br />preparation and operation. Return original to festival coordinator three weeks pnorto <br />this event. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />Wl^tor suoolv dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). A <br />gyrate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-style soag <br />container. <br />of responsible persons to be present in booth during all hours of operation. <br />ue -WkA--------------------------------------------------------