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Page 2FOOD VENDOR PERMIT APPLICATION <br />10. <br />11. <br />12. <br />13. <br />14. <br />10 x io (r Soctn <br />No SnK>Krig S»gn <br /> Fac-er hand Tcweis <br />Soap <br />Cutt-ng Board <br />Soap arid Walei <br />D <br />Ice Cooler <br />Page 2’2 10 14/2015 <br />□ <br />V-l Ice chests <br />□ Refrigerated truck <br />0 Other (specify): <br />□ Refrigerator <br />□ Ice bath and tubs <br />5 Gaf Hand Wash <br />W»W< CGfti&ner <br />Garbage <br />Can <br />Must be on <br />Concrete Asphalt. <br />Plywoofl or a Tarp <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 for adequate hand washing facilities, but separate from utensil washing <br />within my booth: <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 />Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br /> <br /> <br />2-12 Gal <br />Hand Wash Water <br />________ <br />Health Permit <br />Siem-0 wXShaSing <br />Cruft <br />I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils: <br />vOe, Af'ivV u+ei^tis <br />□ 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 />I ©each abd Vrata’ <br />AWater <br /> <br />Ffop-anc! lank <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45’ F: <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 the booth at ail hours of preparation and operation. <br />Bfiturn original to festival coordinator two months prior to this.gyent. <br />Completed by: ------ <br />Signature/Title <br />Fttg Extinguisher | <br />cxfra la) Bags must M sro'wi o* <br />af mo grcunii' <br />Fqm Confawdrs rriusf be <br />of.' the tonr' <br />vendors^ SanJoaquinAsparagujFe8tival.net • 915-370-3647 phone • 209-234-1780 fax <br />PfGpiV-u Slo.-t-