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P.O.�Pex 323 <br /> 307FOG VENDOR'S CHL..ZKLIST <br /> <t^n. Ca!Rcrra 95 <br /> �t'FO <br /> All food vendors (both for profit and nonprofit) are required to return a signed and completed copy of this checklist <br /> to the festival organizer two (2) months prior to this event. Return to: <br /> Fill in bLank or check the appropriate box(es): <br /> 1. \'arae and date of Even, d I h Firs dl/urkr J` AC 7— ' v`rA 30) '2005 <br /> 2 The name, address, and phone number of my organization/business is: V <br /> -��e,-�s6e ���i w�r�sor Piave. vnc�;,tl�cCa gss3-� <br /> x �t:�Ioce)9 5o3 <br /> E-I 3. List food to be sold or given to the public: �'n fh'jcs Ck, -�ee' 140 <br /> 4_ <br /> 0 4. [ ] I am providing no foods which are homemade. All foods are prepared on-site or from <br /> approved non-home and/or commercial facilities. <br /> Name of facility. CV)_5 lE. H. permit <br /> H 5. I am protecting my unpackaged food and food-preparation areas from flies, dust, and the public <br /> by the following methods: <br /> Qa booth with walls and ceiling constructed of either wood, canvas, plastic, similar <br /> material, and (me mesh fly screening, completely enclosing open food areas <br /> W [j a booth with a smooth and cleanable floor (concrete, asphalt, dean tarps and smooth <br /> E-' wood are acceptable) <br /> U [] a booth constructed to separam food and food preparation areas from the public <br /> 0--- [ j other (specify): <br /> a4 NOTE: The only operations not required to provide enclosed booths are those which sell <br /> beverages from approved dispensers, or prepackaged foods from approved sources. <br /> Y� 5. Approved water for drinking, utensil, and handwashing will be provided in my booth by the <br /> following methods: <br /> [ ) approved bottled water (Alhambra, Polar, Sierra Spring, etc.) <br /> n [ ] hese-bib on-site at the festival <br /> D {1' other (specify) 5CA-VCgy%*M'neck W c�Jer-TtvdC, <br /> 7. Elecaic. is �es 11130 <br /> ry provided for my booth's use. <br /> 3. (,]i Yes, I am providing an accurate probe thermometer to measure the hot and cold holding <br /> of potentially hazardous foods during all times of booth operation (S5-S7.00 at resmw_:a t <br /> supply stores). <br /> 9. I am providing the following hot temperature control for the hot holding of all potentially <br /> hazardous foods, above 140 F: <br /> [ j camp stove [ ] stemo & hotel trays <br /> [ ] double steamer [ ) steam table & lids <br /> [ ] eleczic stove top {-mother (specify) oxo-ct"> <br /> *NOTE: potentially hazardous food examples—meats, tamales,cooked beans, rice and vegetables, <br /> potato salad, eggs and dairy products, etc. <br /> E'l 0t 27 See Reverse Side <br />