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P.O. Box 3c8 <br /> ro <br /> SO c!rcti,c. Weter Ce!rtcrria 9_921_1 FOCI VENDOR'S CHL KLIST .. 1 7, <br /> <C/FON�a <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 /> v <br /> 1. ,lame and date of Evenc M aAi 4-P o,. f—�z? ✓`YVLc y-s I"(a-�—� —TitY,4z_-7�� <br /> 2. The name, address, and phone number of my organization/business is: - <br /> CM Zi -�-_Cari& s -P . D . 3� x a�-2 P,(j <br /> x s��+�. , 014asKa7 I /� <br /> Ej 3. List food to be sold or given to the public: R- V P t,1- Po C� s Lt n r� ,r,4 r eP�L r <br /> Q (�ilv <br /> � cJ�h <br /> Q4. [� I am providing no foods which are homemade. All foods are prepared on-site or tom <br /> approved non-home and/or commercial facilities. e <br /> y Name of facility: E H Permit <br /> H <br /> 1 am protecting my unpackaged food and food-preparation areas from flies, dust, and the public <br /> by pe following methods: <br /> Q [ a booth with walls and ceiling constructed of either wood, canvas, plastic, similar <br /> w material, and fine mesh fly screening, completely enclosing open food areas <br /> [ a booth with a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth <br /> E-+ wood are acceptable) <br /> t f <br /> fly a booth constructed to separate food and food preparation areas from the public <br /> Q [ l otter (specify): <br /> 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 /> S. Approved water for drinking, utensil, and handwasbing will be provided in my booth by the <br /> following methods: <br /> IV' <br /> aoproved bottled water (Alhambra, Polar, Sierra Spring, etc.) <br /> [,l' hose-bib on-site at the festival <br /> [ ] other (specify) <br /> i <br /> 7. Electricity is provided for my booth's use. f ]yes 1 � <br /> "�7no <br /> 8. 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 (35-S7.00 at restaurant <br /> supply stores). <br /> 9. I am providing the following Sot temrxramre control for the hot holding of all potentially <br /> hazardous foods* above 140 F: <br /> [ ] camp stove [tK.'sterno & hotel trays <br /> [ ] double steamer ( ] steam table & lids <br /> [ J eleea-ic stove top [ ] other (specify) <br /> -NOTE: potentially hazardous food examples—meats, tamales,cooked bears, rice and vegetables, <br /> potato salad, e_gs and dairy products, etc. <br /> EH 01 27 See Reverse Side <br />