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...ally hazardous foods below10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br />14. <br />Completed by: 15.DateTitle <br />Health Permit <br />Paper Hand Towels <br />$09 p dispenser <br />Gutting Board <br />Blssch <br />Propane Stove <br />propene Tank <br />Fire ^xtinguieher . <br />TEMP EVENT APPPage 8 of 11Jun. 2 1. 20 1 6 2:55PM No. 0908 <br />Rinse Wafer <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Ejdm Ice Begs & Food Conte/nera must Ot? <br />stored 8 inches offofftis gmundl <br />Extra <br />Water <br />S^O Gal. <br />Hand wash Wsnar <br />Garbage <br />Can <br />5 Gal Hand wa&h <br />Wastewater Container <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 />Stemo w/Chaffing <br />Dleh <br /><■ <br />! Ice Cooler <br />Soap and Water <br />‘''Important** <br />Received Time <br />//•l^CIO <br />I am providing the following items within my booth for warewashing, <br />H^Three compartment sink. <br />□ Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />B^etergent, bleach, wiping cloths (cleaning towels), and a tub to store wiping cloths in bleach solution. <br />I am providing the following cold temperature control forth© cold holding of po, <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />©Refrigerator <br />□ Ice bath and tubs <br /> —-— <br />JUO <br />13. lam providing the following for adequate hand washing facilities, but separate from utensil wash within my booth: <br />BzV^ter supply dispenser with warm water at a minimum of 100°F (i.e, 5-20 gaHon^^'ner with spia0^ A <br />separate tub (bucket or basin) for the collection of rinse/wastewater. Paper towels and a pump-s^g spae <br />container. <br />Names of responsible persons to be present ip booth during all hours of operation: <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 hours of <br />preparation and operation. Return original to festival coordinator three weeks priorjo <br />this event. <br /> <br />^Signature '