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Page 2FOOD VENDOR PERMIT APPLICATION <br />10. <br />11. <br />12. <br />13. <br />IMPORTANT <br />Completed by:14. <br />SignaturefTitle <br />Health Permit10 X 10 ft. Booth No Smoking Sign <br /> Paper Hand Towels <br />Soap Dispenser <br />Cutting Board <br /> Clench <br />0 <br />Soap and Water <br />Fire ExtinguisherD <br />Ice Cooler <br />Page 2/2 Rev 10/14/201S <br />Stemo w/Chaffing <br />Dish <br />Garbage <br />Can <br />Must be on <br />Concrete, Asphalt, <br />Plywood or a Tarp <br />2-1/2 Gal. <br />Hand Wash Water <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45° F: <br />5 Gal Hand Wash <br />Waste Water Container <br />Refrigerator <br />□ Ice bath and tubs <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 />Propane Tank <br />I Bleach and Water <br />□ 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 />[^'Paper towels and pump-style soap container. <br />Names of responsible persons to be present in booth during all hours of operation. <br />_____ <br />Extra ice Bags rrvst be stored off <br />of gverd! <br />Food Ceofiinors bn stcrndOff tri ft floor! <br />□ 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 />,'E3\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 />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 cpgrdinat.or tyyo months prior to this^avenL <br />Propane Stove <br />Extra <br />Water