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FOOD VENDOR PERMIT APPLICATION Page 2 <br />10. <br />11. <br />12. <br />13. <br />14.Completed by; <br />Signature/TItle <br />10 X10 ft. Booth Health Permit <br />Papar Hand Twota <br />Soap DlapcnDcr <br />Cutting Board <br />Blwich <br />Propano Tank <br />Firfi Extfhgulflber <br />Ice Cooler( <br />vend0rs@SanJoaquii1AsparagusFe3tival.net • 209-466-5041 phone • 208-4G6-5141 faxP=go2Z2 Rev 11/15/Z014 <br />C Ice chests <br /> Refrigerated truck <br /> Other (specify):__ <br />Sterna w/Chaffing <br />Dish <br />ExVa <br />Water <br />2-1/2 QBl <br />H( nd Wash Water <br />Must be on <br />Concrete, Asphalt, <br />Plywood oraTarp <br />Water supply dispenser (e.g. 5-20 gallons, Igloo or Coleman container with spigot). <br />QJ One separate tub (bucket or basin) for the collection of rinse/waste water. <br />[^fPaper towels and pump-style soap container. <br />5 Gal Hand Wash <br />Waste Water Contalnor <br />Garbage <br />Can <br />Bnefrlgerator <br /> Ice bath and tubs <br />______________________________________OTO <br />j I Soup md Walar | Blamh and Water | <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 />to? fiooff musf ba stomd otr <br />of lha gmivtdl <br />food Contolnarsi must stofod <br />offlholtoori <br />I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils: <br />IMPORTANT <br />All food vendor booths are subject to inspection. Pleas© 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 />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 />I am providing the following for adequate hand washing facilities, but separate from utensil washing <br />within my booth: <br />Names of responsible persons to be present In booth during all hours jf operation: <br /><x ux 6? __________ ____________ <br />I Propane Stove