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1 <br /> d <br /> S A N JUALIHIN I-1,Va1�srlt;;c}t1till 11��,.1tii Depal trr;f,nt - <br /> TEMPORARY FOOD VENDOR'S APPLICATIOM <br /> - ',tolli for prgflt and nor, rr,~;;are req.!lred to return a s, <br /> m `est... __::i ator three(3l vreehs rli:r o thls event <br /> i tiara_ �.,-t L• JCL`2 —FC�1r_�. <br /> 2 The'4'i_,.:-;;is informanon about my organl,atlonfbuslness <br /> Name of organization business _Leon(DLL'`P 7'L- ---- <br /> Add'es5' a-14-A <br /> Phone �.(�' tC _ i,';. ., •, -. <br /> 3 List food to l e sold or given to the public __J_e JQOCL t -�-�- <br /> 4 1 am pro:iding food that is NOT prepared at home:4Yes[j No <br /> r11 food is prepared on`rf or is from approved commercial fatdlties &Yes D Na <br /> Name of facliry. Phone.r 1 <br /> Address of faclLty <br /> 5. 1 am ero:iding a booth wi,h the following:(to protect my unpaeKaged food and food-preparation areas`ram`ias <br /> dust and the public) <br /> A booth Mh walls and ceiling constructed of either wood, canvas, plasm,similar material and fine mesh:'l'; <br /> reaning completely enclosing open food areas. It will also have a smooch 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 /> U Wier(specify) <br /> Note: Tiie only eperalioris not required to provide enclosed booths are those :vhkch sell beveragas from: <br /> approved d spensers or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by ine follo:vina matt•,od_- <br /> Approveo bottled`:later. <br /> On-site hose bib that}s connected to a potable,.rater source <br /> ❑Other(specify): <br /> 7 Electricity is pro vicled for my baath's use.�]Yes No <br /> 8 I arrt providing an accurate probe therrnometef to ,neasure the hot and cold Isoldrng of potz1,t131t7 1,,>�.,i�i c. <br /> foods during all times t,f booth operation gYes[_)No <br /> 9. 1 ant pronding the follo:ling hot temperature control for Hie hot l,old,ng of ati potentially hazardatls 10--os .=.i't`•: <br /> 13VF <br /> [j Cam*,Stove []Slcrno&hotel trays <br /> [,I Double steamer (j Stcain tnbte&lids <br /> 0 Ele-tr,:stove trip VOlher(specify) I GC Chet <br /> Idoto: Examples of potentially hazardous food include: meats, tamales, cooked heans, riot, <br /> ve9wables,potato salad,eggs,arid dairy products. <br /> ,868£ tiazelton Avenue I Slooklon•California 95205I T 209 468-34201 F 209 464-01 3 1 ti`rvvr slc.dlcl oc: <br /> 1 . <br />