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w hazardous foods below <br />11. <br />OR <br />for soapy water, one for rinsing and one for a bleach <br />12. <br />13. lam <br />14. <br />15.Completed by: <br />Date <br />I Health Permit <br />fap&r man-j Toweis <br />Propane Stove <br />Striae Water Bleach and '/.ate <br />Bhire Extinginsner / <br />Ice Cooler <br />Page 8 at 11 TEMP EVENT APP <br />v Ji i <br />] <br />Ex fra Ice Bags & Fooc Coniam&rs trust De <br />siored 6 tr^cttes off of the gicxj^' <br />5 Gai Hand wash <br />W.-jstewaier Container <br />5-20 Cat <br />Hand wash Water <br />./ [ <br />Sanitizer Ducket- <br />bieacli & water for <br />storing wiping doths <br />EHD 16-02 <br />7/14/15 <br /> Ice chests <br /> Refrigerated truck <br />lj Other (specify) <br />Slei iio w>'Cliafftny <br />DiSn <br />Garbage <br />Gan <br />Names of responsible persons to be present in booth during all hours of operation <br />-------------------------------------------------------------------------------------------------------------- <br /> <br />O Three deep tubs (basins 6-8 inches minimum), one <br />solution (one tablespoon of bleach per gallon of water). <br />. <__ <br />~~ <br />Signature <br />"important” <br />Propane Tank <br />I am providing the following items within my booth for warewashing <br />J-t^Three compartment sink. <br />^^-fX <br />Title <br />J <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 m bleach solution <br />^0T^efngerator <br /> Ice bath and tubs <br />St / y^_ <br />Extra J <br />A'ater <br />‘ following cold temperature control for the cold holding of potentially <br />45 F (if food is used the following day, maintain below 41 °F temperature): <br />Booth must be on <br />Concrete. Asphalt <br />Plywood, or a Tarp <br />providing the following for adequate hand washing facilities, but separate from utensil wash within my booth <br />J^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-stvle scan <br />container. ——---------K <br />Al! food vendor booths are subject to inspection Pease 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. <br />CUlwiO Board <br />IF <br />/