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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.I.Name of Event: Date(s): <br />2. <br />Address: <br />3. <br />4. <br />) <br />5. <br /> Other (specify): <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />209 - -342C <br />Page 7 of 11 TEMP EVENT APP <br />the hot ^nd cold holding of potentially hazardous <br />1 Pro^'Hg the following hot temperatur^ontroi7or the hot holding of ail potentially hazardous foods above <br />IOD i . <br />O Camp stove Q Sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />>•"8 £ Haro- <br />EHD 16-02 <br />06^29/2023 <br /> On-site hose bib that is connected to a potable water source. <br />\ 4 , <br /> Other (specify): - <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No <br />6.A <br />are those which sell beverages from <br />sources. <br />•'“I t I .* j ! * <br />Phone: <br />List food to be sold or given to the public^1 <br />I am providing food that is NOT prepared at home: □ Yes^l <br />All food is prepared-orafeita/or is fn <br />Name of facility: //I-—~ ___________________ <br />Address of facility: / ,____•_________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />required to return a signed and completed copy of this checklist to <br />■ ' £ o-'-.-.'.in. Califc- <br />All food vendors (both for profit and non-profit) are r , ’ ’ ’ <br />the festival coordinator three (3) weeks prior to this event. <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />areasalf--omethe^ubhcand SmOOth WO°d are accePtabl®) and constructed to separate food and food preparation <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />S Approved bottled water. ’ ' <br />The following is information about my organization/business: <br />Name of organization/business: ~ <br />Alternate: ( )___________________ <br />- .. MA. <br />-------------------------- .wl^Nd C <br />or is from approved commercial facilities: Yes H No <br />_____________________________Phone: £