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3 /302:57:39 p.m.07-12-20192092396131 <br />10. <br />11. <br />OR <br />12. <br />13. <br />A copy of this checklist must be in the booth at all hours of <br />r-»Annrriinnlnr ♦hran u/ookc nrinr tn <br />this event <br />A Completed by?14. <br />TitleSignature <br />Health Permit <br />I <br />Papor Hand TowoS <br />Soap dupenjor <br />Cutting Board <br />BleachPropane Stove <br />Propano Tank <br />Piro ExtinguisherQ <br />Ice Cooler <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />□i Ice chests <br />□ Refrigerated truck <br />□ Other (specify) <br />Extra <br />Water <br />Garbage <br />Can <br />Booth must be on <br />Concrete, Asphalt, <br />Plywood, or a Tarp. <br />Extra ico Bags & Food Containers must be <br />stored 6 inches off ortho ground’ <br />Stemo w/Chafling <br />Dish <br />5 Gal Hund wash <br />Wastewater Contain er <br />5-20 Gal. <br />Hand wash Wator <br />Sanitizer bucket­ <br />bleach & watar tor <br />storing wiping cioihs <br />/ <br />/ i <br />Rinse Water <br />preparation and operation. Return original to festival coordinator three weeks prior to <br /> <br />Title Date <br />**lmportant** <br />J <br />Soap and Waler <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 4TF temperature): <br />Names of responsible persons to be present in bootp during all hours of operation: <br />AzZxg nJ i — <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event i <br />□ Refrigerator <br />□ Ice bath and tubs <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensils: <br />□ Three compartment sink. <br />H^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 />[TfDetergent, bleach, and wiping cloths (cleaning towels). <br />[J/fTub to store wiping cloths in bleach solution. <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 />Q^ne separate tub (bucket or basin) for the collection of rinse/wastewater. <br />(^fpaper towels and pump-style soap container.