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4 <br />10. <br />11. <br />OR <br />Tub to store wiping doths in bleach solution measuring 1 QOppm. <br />12. <br />13. <br />“Important" <br />14.' . Completed by: <br />Health Pennit <br />Sper Hand Tomatt <br />Ptooane Stome BoaOi <br />Propane Tank <br />Rno Futinoihftar <br />Ice Cooler <br />eara fee fiaos & CoMMfifs must fie <br />30 39Wd aaois san ihi SBSESgt’SS&I Z.s:Z0 3T0E/E0/90 <br />I am providing the following items within my booth for the sanitary cleaning of food prepare ion uten: Is: <br /> Three compartment sink. <br />&-20 GaL <br />Hand mash Wmtor <br />Carbage <br />Can <br />0 Ice chests <br /> Refrigerated truck <br /> Other (specify) <br /> Refrigerator <br />Q Ice bath and tubs <br />5 Gal Hand «flfi <br />Wastewater Contatar <br />^/5- <br />Dato <br />iamtusar buckat <br />each & mater fw <br />mg wiping ootns <br />3oolh must be on <br />kmcrete. Asphalt, <br />lyvKXXi, w a Tarp. <br /> ^^.d“rlri9 al1 houre of operation: <br /> <br />I am providing the following cold temperature control for the cold holding of potentially te zardous xxls below <br />45’F (if food is used the following day, maintain below 41T temperature): <br />Semo WChmtSna <br />bah <br />Title <br />Snap Oepcracr I __ <br />All food vendor booths are subject to inspection. Please make a copy of this a plication in <br />preparation for this event A copy of this checklist must be in the I tooth at JI hotrs of <br />preparatkm and operation. Return original to festival coordinator tires wet ts prior to <br /> <br /> <br />Signature <br />1 am providing the foliowing for adequate hand washing facilities, but separate from utensil was i within my <br />booth: 1 <br />0Water supply dispenser with warm water at a minimum of 10Q“F (i.e. 5-20 gallon contaii >er with s ^ot). <br />Q^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />Ql’aper towels and pump-style soap container. <br />Three deep tubs (basins 6-8 inches minimum), one for soapy water, one for rinsing and one ar a bleach <br />solution (one tablespoon of bleach per gallon of water). <br />Ejoetergent, bleach, and wiping cloths (cleaning towels). <br />Q'Test strips to measure sanitation levels for bleach solution measuring 100ppm. <br />aeacftandWiBw <br />.......Tnr <br />i — r; / <br />I SoapAfifiWater RtescWote <br />1 Cutting Bitertl