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10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />A Three compartment sink. <br />OR <br />12. <br />S^Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />13. <br />14.Completed by: <br />Propane Stove <br />L IE <br />Prepare Tank <br />Soap anP Water Bleacn and Water <br />Ice Cooler J <br />Psge 8 of 11 TEMP EVENT ZaPP <br />J-U’Q <br />Rinse Water <br />n <br />i_i <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 41T temperature): <br />5 Gsi Hand wash <br />Wastewater Container <br />Sanitizer buckst- <br />b’each & water far <br />stertng wiping cotes <br />EHD 16-02 <br />11/4/14 <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />5-20 Gai. <br />Hand wash Waist <br />WOne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />®Paper towels and pump-style soap container. <br />j^Tlce chests <br />□ Refrigerated truck <br />□ Other (specify) <br />I i Refrigerator <br />0 Ice bath and tubs <br />Sterne WChaffina <br />Dish <br />Title <br />Garbage <br />Can <br />Names of responsible persons to be present in booth durino all hours of operation: <br />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 />^Detergent, bleach, and wiping cloths (cleaning towels). <br />Iciest strips to measure sanitation levels for bleach solution measuring 100ppm. <br />Tub to store wiping cloths in bleach solution measuring 100ppm. <br />Extra <br />Water <br />fire Extinguisher I <br />f ■■■■■ - ■, rr— <br />Health Permit p <br />‘‘Important** <br />— \ <br />Soap dispenser | -.....— \ <br />Exfra lc.e Bags & Food Canisters must bs <br />stared 6 inches ah' of the graundl <br />Paper Hand Towel s i <br />Sooth must be on <br />Concrete, Asphalt, <br />Plywood, ora Tarp. <br />J <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 prior to <br />this event. <br />/^ijjnature <br />® . <br />Citing Basra <br />Da<