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Page 2 <br />10. <br />11. <br />12. <br />13. <br />Completed by:.14, <br />IQXlDft. Booitl <br />Paper Hand Towels <br />I ^rpPer>4 I *> <br />Soac and Wsief <br />0Fire Exlinauister <br />Page 2/2 Rev 10/14/2015 <br />Z09Z6PZZOZ IMH-SN WVIE:6O 910? 81- <br />2-1 /2GaL <br />HfiodVVa* Water <br />Sterro wiChaSng <br />Dish <br />Garbage <br />Can <br />Must be on <br />Concrete, Asphalt <br />Plywood or a Tarp <br />SQal Hand Wash <br />Waste Waie< Cowikw <br />I.1K; <br />Ice Cooler <br />I Beech and Water <br />f Extra) <br />I Water | <br />I Propane Siowe <br />(3 ice chests O Refrigerator <br />Q Refrigerated truck ,ce bath and tubs <br /> Other (specify): PIP Cfti ------------------------------------- -------------------------------- <br />I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils: <br />Health Permit K <br />FOOD VENDOR PERMIT APPLICATION <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 />ere subject to jnspection. Heese ntexe Pr‘P*,a"°n “ <br />event. A copy of this checklist must be in the booth at all hours of preparation and operahon. <br />Return original to festival coordinator two month? pepr to this event <br />________________ <br />Signature/Title <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 am providing the following for adequate hand washing facilities, but separate from utensil washing <br />within my booth: <br />0 Water supply dispenser (e.g. 5-20 gallons, Igloo or Coleman container with spigot). <br />[J] One separate tub (bucket or basin) for the collection of rinse/waste water. <br />[JJ Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation: <br />X_________________ _———--------------------------------------- <br />M, -------------------------------------------------------------------— <br />L aBed <br />s^^MaaaaswiWKsa <br />EMFH Ice Bns musf be off <br />.misi be ftorotf <br />aS the fioori _______ <br />vendors@SanJBaquinAsparagusFestival.net • 916-370-3647 phone • 209-234-1780 fax <br />I Cutting Board <br />Na Smoking Sgn £