Laserfiche WebLink
FOOD VENDOR PERMIT APPLICATION Page 2 <br />10. <br />11. <br />12. <br />13. <br />4 <br />14.Completed by:. <br />Signature/Title <br />Health Permitio x to n. Boom <br />No Smo«:Tg S<p <br /> Paper Hand Towels <br />Soap Dispenser <br />Cutting Board <br />0 <br /> Soap and Water <br />Piro ExtinguisherQ <br />Ice Cooler <br />vendors^ SanJ0aquinA5paragusFestival.net • 916-370-3647 phone • 209-234-1780 laxPage 2/2 Rev 10/14/2015 <br />Water supply dispenser (e.g. 5-20 gallons, Igloo or Coleman container with spigot). <br />[2'One separate tub (bucket or basin) for the collection of rinse/waste water. <br />[3 Paper towels and pump-style soap container. <br />I am providing the following for adequate hand washing facilities, but separate from utensil washing <br />within my booth: <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 />Stemo w/ChaHing <br />Dish <br />Extra <br />Water <br />Garbage <br />Can <br /> Must be on <br /> Concrete, Asphalt, <br />Plywood or a Tarp <br />5 Gal Hand Wash <br />Waste Water Container <br />2-1/2 Gal. <br />Hand Wash Waler <br />Names of responsible persons to be present in booth during all hours of operation: <br />(cand u c ._______________________________ <br />Lvixdf._____________________________ <br /> <br />Propane Tank <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods <br />below 45° F: <br />J | Bleach and Wale, | <br />IMPORTANT <br />Ail 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 />I am providing the following items within my booth for the sanitary cleaning of food-preparation utensils: <br />Q. t6n <br />II 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 />Extra lea Bags must Da stored c-H <br />of the ground1 <br />Food Gcntarr.ers must be stored <br />on the floor' <br /> Ice chests Refrigerator <br /> Refrigerated truck Ice bath and tubs <br /> Other (specify): H-’ / -i-X id