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Page 2FOOD VENDOR PERMIT APPLICATION <br />10. <br />11. <br />12. <br />13. <br />Completed by:14. <br />Signature/Title <br />Health Permit <br />10 X 10 ft. Booth <br />Paper Hand Towels <br />Soap Dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Propane Tank <br />Bleach and WaterSoap and Water <br />Fire Extinguisher <br />IIce Cooler <br />Page 2/2 Rev 10/14/2015 <br />Stemo w/Chaffing <br />Dish <br />Refrigerator <br />0 Ice bath and tubs <br />5 Gal Hand Wash <br />Waste Water Container <br />Extra <br />Water <br />2-1/2 Gai. <br />Hand Wash Water <br />Garbage <br />Can <br />Must be on <br />Concrete, Asphalt, <br />Plywood 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 />L <br />: <br />No Smoking Sign <br />_______ _ ___ <br />Extra Ice Bags must be stored off <br />of the ground! <br />Food Containers must be stored <br />off the floor! <br />vend0rs@SanJ03quinAsparagusFestival.net • 916-370-3647 phone • 209-234-1780 fax <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45° F: <br />[JThree 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 />AHoS^dllbooths 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 />[2] Ice chests <br />□ Refrigerated truck <br />□ Other (specify): <br />I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils: <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 />[TJI^aper towels and pump-style soap container./ <br />Names of responsible persons to be present in booth during all hours of operation: <br />Zz// U _______ <br />l/Jt Lh ---------------------------—-----------------