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11. <br />OR <br />* Tub to store wiping cloths in bleach solution measuring lOOppm. <br />12. <br />“Important" ' <br />Completed by: 14. <br />Health Permit <br />p«pv HtndTONM <br />Propana Stow <br />MaManpwttarRlniawatarSoap and waw <br />Fira Enarsgulahar <br />Ice Cooler <br />‘ PagaatfU TEMP EVENT APPEHO 16-02 <br />11W1« <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br />O Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />StamowAtwKIng <br />Dm <br />8 Gsi Hand waah <br />MWawalarContakw <br />.1 am providing the following for adequate hand washing facilities, but. separate from utensil wash within my <br />bdoth; <br />BanNUtarbudkat- <br />UaadtJlwMarkr <br />■taring wiping eklha <br />Title <br />Propane link , <br />IP' <br />............ ' ----s Booth muat be on <br />Concrete. Aiphalt. <br />Plywood, or a Tarp- <br />>._______:_____J <br />Zb <br />' Garbage <br />Can <br />ammaa^alAaxTCBnaawiimatM I <br />■HaddtKMtoVaftMgKMdl ■ <br />■/-1± 1^ <br />□ata <br />I am providing the folfowing items within my booth for tha,senitary cleaning of food preparation utensils: <br />fp. Three compartment sink. <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 />llgnature <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 dll hours of <br />preparation and operation Ratum Oflfllnal to ftdtlval coordinator three weaKt Prior to <br />tbM <br />Bdr* wmr <br />MO GM <br />' Hud W*w <br />10. lam providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />•456F (If food is used the following day, maintain below 41 °F temperature): . <br />t^fjce chests ^Refrigerator <br />• Refrigerated truck Ice bath and tubs ’ <br /> Other (specify)^ . . <br />I CuttngBowd <br />Water supply dispenser with warm water at a minimum of 100°F (Le. 5-20 gallon container with spigot). <br />[^One separate tub (bucket ar basin) for the collection of rinse/wastewater. <br />• fylPaper towels and pumo-stvle soap container. ’ <br />13. Names of responsible persons.to. be present in booth during all hours of operation: <br />Blweh