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4 <br />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 />13. <br />14. <br />Health Permit10X10 ft Booth <br />No Smoking Sign <br />Paper Hand Towels <br />Cutting Board <br />Bleach <br />Soap and Water Bleach and Water <br />Q <br />Ice Cooler <br />vendors@SanJoaquinAsparagusFestival.net • 916-370-3647 phone • 209-234-1780 faxPage 2/2 Rev 10/14/2015 <br />Q Ice chests <br />Q Refrigerated truck <br />0 Other (specify):__ <br />0 Water supply dispenser (e.g. 5-20 gallons, Igloo or Coleman container with spigot). <br />0 One separate tub (bucket or basin) for the collection of rinse/waste water. <br />0 Paper towels and pump-style soap container. <br />Stemo w/Chafling <br />Dish <br />5 Gal Hand Wash <br />Waste Water Container <br />Garbage <br />Can <br />Must be on <br />Concrete, Asphalt, <br />Plywood or a Tarp <br />0 Three compartment sink. <br />0 Two deep tubs (basins 6-8 inches minimum), one for soapy water, the other for rinse and bleach solution. <br />0 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 />Names of responsible persons to be present in booth during all hours of operation: <br />Mariah Vitoria <br />2-1/2 Gal. <br />Hand Wash Water <br />0 Refrigerator <br />0 Ice bath and tubs <br />FREEZER <br />Extra <br />Water <br />Extra i <br />of the. <br />Food < <br />off the floor! <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 />fee Bags must be stored off <br />> ground! <br />Containers must be stored <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45° F: <br />j I Fira Extinguisher I <br />I Propane Stove <br />I Propane Tank <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 be in the booth at all hours of preparation and operation. <br />Return original to festival coordinator two months prior to this event. <br />Completed by: /MaTUPvHj F____________ _ ____________________________________________ <br />Signature/Title