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J <br />SAN JSASuiN <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address:C.r) e <br />Phone: <br />3. <br />4. <br />4^ <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />3 <br />7. <br />8. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />!6';8 t. I lazfjltcr. •\v7i -iG I Stock-on Cislit’rjfva 55205 ] <br />EHD 16-02 Page 7 0111 <br />06/29/2023 <br />foods during ail times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Dptfble steamer <br />Pl Electric stove top <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />[IfOther (specify): , n ,___________________________ <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />} / / j,- <br />I am providing food that is NOT prepared at home: ^Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: _( Phone: /SX - "7^ ^3 <br />Address of facility: S' W, ))hSf C o , )J | <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 />Name of organization/business: <br />i tv7. <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />AHood vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />Date(s): <br />Q 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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />the festival coordinator three (3) weeks prior to this event. <br />1 .Name of Event: <br /> Stejno'S hotel trays <br />0Steam table & lids <br />Q Other (specify) <br />The following is information about my organization/business: <br />_^|| <br />List food to be sold or given to the public: <br />________________________ <br />Alternate: ( /) 7 ? Y <br />09 46ft-34 Kl | F 205 46 ' . wvw sig <br />TEMP EVENT APP