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10. <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils:11. <br />□ Three compartment sink. <br />OR <br />12. <br />M.' ■ <br />14. Completed by:Date'Signature <br />Health Permit <br />Paper Hand Towels <br />Soap tfespenser <br />4Cutting Soard <br />BleachPropane Stove <br />[ <br />& <br />Propene Tank <br />Bleach and WaferRinse WaterSoap and Water <br />Hre ErttoguKher <br />Ice Cooler | <br />TEMP EVENT AFP <br /> <br />Page 8 of 11 <br />II <br />"important” <br />EHDIfrOZ <br />11/4/14 <br />■S-lqs chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Sterna vChaflmg <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Cordsuwr <br />Water supply dispenser with warm water at a minimum of 100’F (i.e. 5-20 gallon container with spigot), <br />fcfone separate tub (bucket or basin) for the coBection of rinse/wastewater. <br />SPaper towels and pump-style soap container. <br />Sani&w bucket’ <br />bleach & water for <br />storing w^ingctofhs <br />X <br />& <br />Title <br />Extra toe Ba^s Food Containers must be <br />stored 6 toches off of the ^ound! <br />I‘''' <br />13. Names of responsible persons to be present in booth during all hours of operation: <br />zi j______________Q, • { .......... .............................................................................. <br />Detergent bleach, and wiping cloths (cleaning towels). <br />• gfr^t strips to measure sanitation levels for bleach solution measuring 10Oppm. <br />0Jub to store wiping cloths in bleach solution measuring lOOppm. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br />&-20 Gal. <br />Hand wash Waer <br />/ "r’ <br />I am providing the following cota temperature control for the cold holding of pots, .ily hazardous foods below <br />45°F (if food is used the following day, maintain below 41 °F temperature): <br />E]'Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one for a bleach <br />Sution (one tablespoon of bleach per gallon of water). <br />Gabage <br />Can <br />u~~~a <br />Z----------------------------X <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp- <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this evept. A copy of this cheddist must be in the booth at aB hours of <br />preparatioruand opengfeh. Return original to festival coordinator three weeks prior to <br />this event j/l /