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10. <br />a/A <br />11.I am providing the following items within my booth for warewashing: <br />□ Three compartment sink <br />OR <br />12. <br />13. <br />14 Names of responsible persons to be present in booth during all hours of operation. <br />15.Completed by <br />Health Permit V <br />Paper Hand Towels <br />Propene Stove BJeacT: <br />0fl <br />Soap and Waler Bleacti and Water <br />Ice Cooler <br />Page 8 of 11 TEMP EVENT APP <br />Pre Ex!?ngurgher <br />/ 7 <br />1 <br />( <br />r7 <br />LJ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <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 />Slernc w/Chaffi-ig <br />Osh <br />5 Gai Hand wash <br />Wastewater ContanerExtra >ce Bags & Food Containers irust Oe <br />stored 6 inches off of the ground' <br />□ Refrigerator <br />Q Ice bath and tubs <br />Booth must be on <br />Concrete, Asphalt. <br />Plywood, or a Tarp <br />EHO 16-02 <br />7/14/15 <br />5-20 Gal <br />Hand wash Wate- <br />i Samteer bucket- <br />dieacn & water for <br />slonng wping doths <br />7-4 <br />Date <br />I <br />Garbage <br />Can <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 />Title <br />“Important** <br />/ 7 <br />Signature <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 evenjz <br />[ txtra <br />Water <br />r_z <br />Rinse Water <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 nnse/wastewater. Paper towels and a pump-style soap <br />container. <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 />Cutting Board