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S A NW Q U I N Environmental Heath Department <br /> (A C'jU 1�„v <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> .All food vends rs(both for pro`s and non-prafit)are required to return a sign and completed copy of this chat klist to <br /> ft festival coordinat a(3)weeks prior to thts event <br /> Na <br /> .1. t. meofEvent' <br /> t <br /> 2. The follrnving is information abo y organizationlbusk=s: <br /> N,,We of crganizatiortRslrsiness. <br /> Address. i* AYa <br /> Phone: � <br /> } Alterrsa;e-( ) <br /> 3. Us4 food to?b-- old or given to the pub[ <br /> d, J am providing food that is NOT prepared at home-WYes❑No <br /> /MI food is prepared on-sire or is from approved commercial facilities: Q Yes❑No <br /> Name of facility, phone: <br /> Address of facility. <br /> 5, I am providing a booth with the faucwing: (to pra,'ect my unparkaged food and food.preparation area`from flies, <br /> dust and the pubtit) <br /> ❑A booth with wails and ceiling constructed of either wood,carrvas,plastic srmtiair material and fine mesh fly <br /> screening, completely enclosing open food are-.as. It wril also have 3 s:noo!h and cJeanabie floor (concWe, <br /> asphalt, clean tarps and smooth wood are acceptable)and oo nstructed to separate food and food preparation <br /> areas from the publ' <br /> /` <br /> Note: The only operaii+ons not reWirod to provide enclosed bocxhv are those which sell bcvc.agPs from <br /> approved dispensers,or prepackoged foods from approved sauroes. <br /> G. Approved water for drinking,utensil and hand washing wiii be provided in my booth by the following methods: <br /> ❑Approvod b&Jed v rater. <br /> Qr mite hose bib that is corwtedod to a Potable water source_ <br /> I]Other(sp=9y); <br /> i. Electricity is priovxied for my booih's uso.V Yes,❑No <br /> 8, 1 am providing an ac=ate probe therniorfiefer to measure the hat and cold holding of potentially hazardous <br /> foods during all times of booth operation: []Yes❑No <br /> 9_ 1 am providing the following hot temperature control for the hot holding of ail potentiallyy har_ardovs foods above <br /> 135°F; <br /> k❑ amp stave (�Sterna&Wei trays <br /> , {Double steamer ❑Stearn table&lids <br /> 0 E6?ctric stove top 0 Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad4 eggs.and dairy prod3rcts, <br /> 1t58 F HP7Ct<on Avenue; Stv..:k`.o:x, Californfa 952051 T M 46F,3426 f F 209 484-0138 i vm w.sigov orfictid <br /> EHD 1610 PD901011 Yt 11tP +r API' <br /> CUE is <br />