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:• <br />3'.: <br />< <br />5: <br />6. <br />I.i <br />» MAU lmi Hia.V.i’cxuBaUun „ <br />t. <br />2- <br />7: <br />9. <br />- <br />f <br />i.L <br />zV <br />Erivirdnitehtal Health <br />IlgHazeitorf^MIrO®; P pUs^OlSb. I:;WWW;^^.^ <br />‘o?/?/ n <br />___________ Alternate'^ •= _^----------- <br />PACKAGED CUSTOM SUGAR COOKIES <br />BWB: <br />TEMPGRARY FOOD VENDOR’S. APPLJCATION <br />AIlTocd veridors :(both:forprofiVand nonprofit) aTe;required:to:return a signed and completed-copy: O^liisMO.ist to <br />WeS&aKc^^ . . . _ , <br />OamedfEvent: LODI STREETFAIRE,,... . ......:.. ... . . .. _ . ..,tDaW Mft>j <br />TheTolldWing is. iriformatibn afidUt my- Grganfeaferi/bqslness-: 0 Q <br />Narae^fprg^nizaiion^usihe'ss: MAMA'S TOUCH SPECIALTIES ....... ■■ . - -- -------^■ <br />A,. 21600 N KENNEFICK RD ACAMPO CA 95220iAtoss —. :■.............■•:■■-■ M-. •■.:-::--..v.7.....— ----------------------------------------------- <br />Phone: • (209..) . 327-0548 . <br />List-food to be soid grgiyendo th^pubficr. <br />l-am providing :fopd th.^Hs. NQTprepared at-home: .□ Yes $ Nd. <br />All fbodls prepared bn^itapr & to/approyediwW'ercial-^ <br />Name;o'ffacility.- .......................Fhtine;£__------------------------------------------------------------------^— <br />Ato§s;5Kfecj|i’iji':________________ — -7 , -------—-------:—I am-prbviding:« booth' wiyittheTolioWingtTthtpratect-rny.unpackaged food 'andTopd-prepatatidpareas frontflies, <br />dUslMhejpobjioj ' <br />□: A booth With walls and;ceillrig: GOflstrWd d«er cppy^.plast^similar rnafehal andTInemesh fly <br />screening, coinpletely. eriolosi^ Wl ..alsp':haye § smooth ;and oleanabl^flobr ^(concrete, <br />asphalt; tibari tarps;ahd smo’oth; Wp'od are acceptable) and consiructed to separateTood and food preparation <br />areas-frbmjth&publjb-. <br /> -Cther/spedify): _________... ————-— -----------------------------------------— <br />Note: The only operations ndt required dh: p.rdyi.de- enclosed booths W those which eell beverages from <br />7 epproyed dispense'rb; ior prepackagepfoodsTom approved -sources. <br />. Approyed-Wal^ hand washing will.be pidyidedlamy booth by’the following methods!- <br />* <br />□i.Approvedbottled wateh. <br />□•Onsite hose bib.lhatjs ^nnected:tOa ppiablewater source. <br />i~1 Q'tli^r (specif):.____________________________________- ............ „ — ■___ .... ........ <br />Elebiridity]s provided for my booth's.use? QWDMci’ . ... <br />.[ providing en accurate hpf and. cold; hold>.< P9tentia!!y< hazardous <br />I am h^Lbolding of all potentially: hazardous foods abpye <br />TSS’Fv. <br /> Gamp.stpye Sterno/&-hoteT trays <br /> Double steamer- □'•Steam table § lids: <br /> Eleqtribsfoye top; □^ttter- (specify) <br />jjptfeJExamples of potentially hazardous ifbpd include: meats; tamaJes, cooked beans, rice, <br />vegetables; potato saldd, eggs,mid.daily products-.-