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img082.jpg Page 1 of 1 <br />10. <br />it <br />OR <br />12. <br />13. <br />14. <br />Nor nfr j J <br />“Important" <br />i <br />15.Completed by: <br />Signature Date <br />Health Permit <br />Paper Hand Towels <br />Propane Stove <br />0 <br />Propane Tank <br />Bleach and Water <br />Fire Extinguisher <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />https://mail.google.eom/_/scs/mail-static/_/js/k-gmail.main.en.4L9b VmWxiEc.O/m=m_i,t...6/14/2016 <br />EHD 16-02 <br />7/14/15 <br />0"lce chests <br />□ Refrigerated truck <br />□Other (specify) "I57 r~r <br />Extra ice Bags & Food Containers must be <br />stored 6 inches oN of the ground1 <br />Extra <br />Water <br />5 Gai Hand wash <br />Wastewater Container <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />I am providing the following items within my booth for warewashing: <br />Q Three compartment sink. <br />5-20 Gal <br />Hand wash Water <br />Sanitizer bucket- <br />Dleach & water for <br />storing wiping cloths <br />Sterno w/Chaffing <br />Dish <br />□Refrigerator <br />□ Ice bath and tubs <br />Tt z €•><■—____________ <br />Names of responsible persons to be present in booth during all hours of operation <br />---tSmc. I d__1-4.4? . IC <br />1 <br />± <br />Rinse Water <br />Garbage <br />Can <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 />this event. i <br />(Lo- <br />Title <br />z <br />Soap and Water <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45T (if food is used the following day, maintain below 4rF temperature): <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />□ Water supply dispenser with warm water at a minimum of 100oF (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-stvle soao <br />container. —----- <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 />U 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 />Culling Board