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r. uujTHA HU, JI U JJJ 1 000SjCI ILC1 <br />FOOD VENDOR PERMIT APPLICATION Page 2 <br />10. <br />11. <br />12. <br />13. <br />A14.Completed by:. <br />10X10 ft. Booth <br />Paper Hand Towels <br />Bo op Dbponw <br />GuNldfl BOftfd <br />Bloaoti <br />Prqrane Stove <br />Boap and Water <br />Fire Extinguisher <br />Ice Cooler <br />vendors@SanJoaquinAsparagusFestival.net • 916-370-3647 phone • 209-234-1780 faxPage 2/? Rav 10/14/^015 <br />E^lcs chests <br />□ Refrigerated truck <br />□ Other (specify): <br />Stoma w/ChaffWig <br />Oish <br />Garbage <br />Can , <br />Must ba.on <br />Concrete, Asphalt, <br />Plywood or a Tarp <br />I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils: <br />j^Three compartment sink. <br />Epwo deep tubs (basins 6-8 inches minimum), one for soapy water, the other for rinse and bleach solution. <br />[j Detergent, bleach and water (one cap full per gallon of 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 />5 Gal Hana Wish <br />Waale Waler Container <br />a-i/atM <br />Hand Wash Water <br />Names of responsible persons to be present in booth during all hours of operation: <br /><^\C^ _________-__________________________________ <br />Extra, <br />water <br />□ Refrigerator <br />Ice bath and tubs <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45“ F: <br />I Bleach and water <br />1 <br />IMPORTANT <br />Ail 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 the booth at all hours of preparation and operation. <br />Return original to festival coordinator two months Prior to this event. <br />I am providing the following for adequate hand washing facilities, but separate from utensil washing <br />within my booth: <br />Q^A/ater supply dispenser (e.g. 5-20 gallons, Igloo or Coleman container with spigot). <br />|\]Z)ne separate tub (bucket or basin) for the collection of rinse/waste water. <br />[^*aper towels and pump-style soap container. <br />Health PermitNo Smcking Sign , fjj <br />Bdrs /eg qit <br />of the around! <br />Food Gonlainero muol bo storod <br />oJf lha ncatl <br />Signature/fltte t <br />mr\L\/ iiz z.u i u/ wivn uz.. uj i m <br />Fropangl^K I <br />iui Diuers