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FHUE.U J/ UJ <br />FOOD VENDOR PERMIT APPLICATION Page 2 <br />10. <br />11.I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils: <br />12. <br />13. <br />Completed by:.14. <br />I10X10 A. Booth <br />No SffioHnf etflfi <br />Paper Hand Towels <br />Cutting Board <br />Bleach <br />8oap and Water Bleach end W^ter <br />Ice Cooler <br />• 209-234-1750 faxPage 2/2 Rev 10/14/2015 <br />Q^TThree 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 />^4 Ice chests <br />Q Refrigerated truck <br />Q Other (specify): <br />I am providing the following for adequate hand washing facilities, but separate from utensil washing <br />within my booth: <br />Extra <br />Water <br />Must be on <br />Concrete. Asphalt, <br />Plywood or a Tarp <br />d 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 rlnse/waste water. <br />M Paper towels and pump-style soap container. <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45’ F: <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 />Slemo w/Chflfflng <br />Dish <br />jX.Refriqerator <br />Pj Ice bath and tubs <br />6 Gal I l*nd Wuh <br />Waste Water GonWner <br />2-1/2 GaJ. <br />Hard Wwh Water <br />Garbage <br />Can <br />Health Permit <br />71 <br />Extra, tc^ Jrvvtwd off ’x <br />rbod mu^t <br />ctr the floor! <br />Rro Extingu)»h9^ J <br />Names of responsible persons to be present tn booth during all hours of operation: <br />Mi-IVL- TLJIIMM <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 bejq the booth at ajkhours of preparation and operation. <br />Return original to festival coordinateftWo mpnffisjyjdrto this event <br />^'^Sighatdre/r^^^ <br />| Propane Stovo <br />I Propana Tank