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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 />Names of responsible persi13. <br />14. <br />Signature/Title <br />Health Permit10 X 10 ft. Booth <br />No Smoking Sign <br />Paper Hand Towels <br />Cutting Board <br />Bleach <br />Soap and Water <br />Fire ExtinguisherQ <br />Ice Cooler <br />vsndofS'&SanJoaquinAsparagusFestival.net • 916-370-3647 phone • 209’234’1780 faxPage 2/2 Rev 10/14/2015 <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 />Stemo wTChaffing <br />Dish <br />□ Refrigerator <br />□ Ice bath and tubs <br />Must be on <br />Concrete, Asphalt, <br />Plywood or a Tarp <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 />Garbage <br />Can <br />5 Gal Hand Wash <br />Waste Water Container <br />2-1/2 Gal. <br />Hand Wash water <br />Extra <br />Water <br />Propane Tank <br />T <br />Extra Ice Bags must be stored oft <br />cl the ground! <br />Food Containers must be stored <br />off the floor! <br />Bleach and Water I <br />to be present in booth during all hours of operation: <br />ArY25 <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45° F: <br />□ Ice chests <br />□ Refrigerated truck <br />□ Other (specify): <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 musTSe in fReTjoqth at ail hours of preparation and operation. <br />Return original to festiy.at'c<?ordina{tor two months)prior to this event. <br />Completed by: <br />Soap Dispenser <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 />Propane Stova