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Ehvjb’on,mj r(-•1J ’• <br />. )^:. <br />5. <br />w <br />yiv<|- <br />,'■'■■■■. ' . ■ <br />' ■ ■;<■:•' '■? <br /> Allernale: ( <br />Baked goods <br />I ] S|e$o & hole! hays <br />I. JStoarr) tables lids ■ . <br /> r.ledric stove top ■ . . . . | | Olb'er^iecify) - <br />■ ' ' '' . . ■ ■ ■ ' • <br />Note: Examples of potentially hazardous food Include:: ■ <br />vegetables, potato salad, oggs, and dairy' pj oducis, <br />1068 I . i lazclton Avenue ; Stocldon, Cnlifornia 95205 J -I 209 468-3420 I <br />MIO1C> J? PnnaZol li <br />SAN .IOAO.UIN <br />-C oi JN-T.Y ' - <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendor (both for prtl and iWn-proll!)'are roqulred Io relum a signod and completed copy of this checklist to <br />th.o festival coordinatoi three (3) weeks.prior to this event, , 6-9/5 <br />t I Na.noofkvoni LodjIa_rm_eLS_market ...........................— <br /> NameoroW^cksdn ave .escafon ca95320-------------------- <br />Address: . k-- ■ <br /> ^<585-89611 <br />List food to be sold or given to the publip: \ <br />4. I am providing food that is NOT prepared at hoine:.|2] Yes I j No <br />All food is WaraS rrtiSO- bO'ko/‘VY,';'1 209-585-8961 <br />'N^fooifaciiiiy: . .2251 Jackson avrjArstAiion "caObdzi —r^sfe <br />Address of facility:... • "• . 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 />0 A booth with walls and ceiling constructed of cither 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)fond cqnstructod to separate food and food preparation <br />areas from the public ' ■ , <br /> Other (specify), k - - ■ ■ ’ ■ ' ;; " „. ■ <br />Note: The only operations not required, to provide enclosed booths-are those vzhich sell beverages from <br />apjKOved dispensers, or prepackaged foods from ^approved sources. <br />6. Approved water for drinking, Utensil and hand washing will ba provided in my booth by the following methods: <br /> Approved bottled waler. <br /> On site hose bib (bat is connected fo a potable water sou:co <br /> Other(specify). . ___ _ _ _____ <br />Ele.GkicIty'.i^^ , <br />I am providing,an accurate probe ttiermomeler to, measure the hot and cold holding of potentially hazardous i <br />foods during all times of booth oparalion: El Yes No . .J <br />i fon providing the. following hot temperature contjol fof.tha hot holding of all potentially hazardous foods above ' <br />■13o Fi.. ■'. •. <br /> <br />meats, tam'alej;, cooked beans, rice, <br />■ ? . A ' <br />E 209 45(1-0138 ) VAWxsjnolKl.com <br />' If MPLVENf Aff <br />8. <br />9. <br />( J Camp stove. . <br /> Double steadier