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Page 2FOOD VENDOR PERMIT APPLICATION <br />10. <br />I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils:11. <br />12. <br />13. <br />Completed by:.14. <br />Signature/Title <br />Health Permit10 X 10 ft. Booth <br />Na Smoking Sign <br />Paper Hand Towels <br />Soap Dispenser <br />Cutting Board <br />Q <br />Ice Cooler <br />vendorscs’SanJoaquinAsparagusFestival.net • 916-370-3647 phone ■ 209-234-1780 faxPage 2/2 Rev 10/14/2015 <br />0 Three compartment sink. <br />□ Two deep tubs (basins 6-8 inches minimum), one for soapy water, the other for rinse and bleach solution. <br />□ Detergent, bleach and water (one cap full per gallon of water). <br />□ Water supply dispenser (e.g. 5-20 gallons, Igloo or Coleman container with spigot). <br />□ One separate tub (bucket or basin) for the collection of rinse/waste water. <br />|3<Paper towels and pump-styie soap container. <br />I am providing the following tor adequate hand washing facilities, but separate from utensil washing <br />within my booth: <br />Stemo w/Chaffing <br />Disll <br />Garbage <br />Can <br />□ Ice chests <br />,^] Refrigerated truck <br />□ Other (specify): <br />,'1X Refrigerator <br />□ Ice bath and tubs <br />Must be on <br />Concrete, Asphalt, <br />Plywood or a Tarp <br />5 Gel Hand Wash <br />Waste Water Contain*: <br />2-112 Gal. <br />Hand Wash Water <br />/ Extra \ <br />Water <br />Your hot & cold food temperatures will be monitored. Your hand washing and sanitation processes will <br />be checked. PLEASE meet the required standards as addressed herein. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45° F: <br />E*fr» Ice Bafp Tiust be stored aM <br />at the around! <br />Food Containers most be stored <br />otl the floor! <br />IMPORTANT <br />All food vendor booths are subject to inspection. Please make yourself a copy of this application in preparation for this <br />event. A copy of this checklist must be in tire booth at all hours of preparation and operation. <br />Return original to festival coordinator two months prior to this event. <br />Fir* Extinguisher I <br />Names of responsible persons to be present in booth during all hours of operation: <br />I Propane Stove <br />I Propane Tank I <br />So»p and Water Bleach and Water