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I ' a s t TEMPORARY FOOD VENDOR'S APPLICATION s All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of Event: Mountain House Restaurant Night Date(s): 4/16/2016 4 2. The following is information about my organ[zation/business: Name of organization/business; SACRESUCRE � I Address: 69 W Atento Ln, Mountain House, CA 95391 Phone: (401 ) 2618171 Alternate: French Macarons a 3. List food to be sold or given to the public: 1 I 4. I am providing food that is Nt77 prepared at home: 0 Yes[]No All food is prepared on site or is from approved commercial facilities:©Yes❑ No Name of facility: Central Valley Kitchen Phone: 209 339-8629 g Address of facility: 259 S Guild Ave, Lodi CA 95240 5. I am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from files, dust and the public) Fx1 A booth with walls and ceiling constructed of either wood, canvas, plastic,similar material and fine mesh fly ` screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. > i ❑Other(specify): S Note: The only operations not required to provide enclosed booths are those which sell beverages from I approved dispensers,or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ; ®Approved bottled water. f ❑On-site hose bib that is connected to a potable water source. I ❑Other(specify): 4 a 7. Electricity is provided for my booth's use: ❑Yes® No 8. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous € foods during alf times of booth operation: ❑Yes Lq No I 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above E 135�F: ❑camp stave ❑sterno&hotel trays f ❑Double steamer ❑Steam table&lids i ❑Electric stove top ❑Other(specify) Note: I~xamples of potentially hazardous food include: meats, tamales, cooked beans, rice, . a vegetables,potato salad,eggs,and dairy products. ` a EHO 16-02 Page 7 of 11 TEMP EVENT APP 7114/15 r