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10. <br />11. <br />OR <br />12. <br />2.^/ <br />14.iT Signature <br />Health Permit <br />I Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Bleach and WaterRinse Water. Soap and Water <br />Fire Extinguisher <br />Ice Cooler <br />TEMP EVENT APP <br />Page 8 of 11EHD 16-02 <br />11/4/14 <br />. Refrigerator <br /> Ice bath and tubs <br />5 Gal Hand wash <br />Wastewater Container <br />5-20 Gal. <br />Hand wash Water <br />Garbage <br />Can <br />SaniSzar bucket­ <br />bleach .& water for <br />storing wiping cloths <br />Stemo w/Chafflng <br />Dish <br />Extra, <br />Water <br />Completed by:pA^e<Title /Date <br />Propane T§nk <br />f <br />"important** <br />‘ Xl ice chests <br />• Refrigerated truck <br /> Other (specify)_ <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />Extra Ice Bags & Food Containers must be || <br />stored 6 Inches off of the ground! ■ <br /> 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 /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Test strips to measure sanitation levels for bleach solution measuring lOOppm. <br /> Tub to store wiping cloths in bleach solution measuring 100ppm. <br />I am providing the following for adequate hand washing facilities, but. separate from utensil wash within my <br />booth: <br /> Water supply dispenser with warm water at a minimum of 100°F (i.e. 5-20 gallon container with spigot). <br />J3^0ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />.^^TPapftrtowels and pump-style soap container. <br />13. Names of responsible persons tqbe present in booth during all hours of operation. <br />/>/______________________________________________________________;------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ■ <br />z : <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp, <br />k________—-------------Z <br />_______________________________________________________ _______ _______________________________________________________________________________________ __________________________________________ _____________ ■ <br />Ail food vendor booths are subject to inspection. Please make a copy, of this> aPP1'^1®" <br />oreparation for this event. A copy of this checklist must be in the booth at aH hours of <br />preparation and operation. Return original to festival coordinator three weeks pnor to <br />this event. <br />u