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t <br /> SAN �(jf�( ���N I:,Y1vi1Y11111 elita1 f- eal(l� I)c�la�trFlrtr�n� <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(bath for profit and nor)-profit)are rragnired to return a signed and r;ompleted copy of this checklist to <br /> the festival coordinator It e(3)weeks pnortohis event <br /> �f c, <br /> 1. 1.Nomeof[vent: f'(�� `_7iiP �lfC.� � Dale(s) � � <br /> i� <br /> 2 The l is information about lily nrryani�atinnlhusines5 <br /> w Name of a(rdanizationh)usinessca <br /> Address' 303 t�7 <br /> Phone (76q ).10 ._2.--- 4 6 Alternate:( )q ) <br /> i <br /> A. List food to be sold or given to the public <br /> 4 1 am providing food that is NOT prepared al home )Yes❑No <br /> All food is prepared en-site or is from approved carnmeicial facilities: Yes J J No <br /> i ( <br /> Name of facility. � t1 / y__ � �L'C. !r?t{'f t Phone Gc4.1 �`I Z _ 1✓��i� <br /> Address of facility,�� l-Fl�l7fLtL r <br /> 5. 1 am providing a booth with the l (to protect my unpackaged rood and food-prepaiation areas frum IfrCz.. <br /> dust and the public) <br /> r' <br /> ElA booth with walls and ceding constructed of eilher wood,camas,plastic,similar material and fine mesh fly <br /> screening, completely enclosing open food areas. It will also have it smoatlt 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 /> �i <br /> IJ l Other(sp'City): VI 1 1 ti`,[i E? — yL1 t ► — <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 /> v <br /> 6. Approved water for drinking,ulensd and hand vrashrng will be provided in my booth by the foflorwing methods <br /> r <br /> ❑Approved bottled water. <br /> ❑On-site(rose bib that is connected to a potable waa of of rce. <br /> 41ectricily <br /> s ecif r d 1 II j 5ther( p Y) I7. is provided far my ooth's use: Yes(�No <br /> $. I am providing an accurate probe there omet�r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of buoth opeialion: Yes[]Nv <br /> 9. 1 am providing the following hat temperatu a control for the hot holding of all potentially hazardous foods above <br /> 135"F: <br /> ❑camp stove ❑Sterno&hotel frays <br /> ❑Double steamer ❑Steam table&fids <br /> ❑Electric stove topOthat(specify) 1 <br /> //A- <br /> Note, Examples of poter)tlally hON-11Mells food In ludo: meats, tarunles, cooker) beans, lice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E.Hazelton Avenue I Stockton,California 452051 T 200 460-3420 I F 209 164.0138 1 www.sicehd.com <br /> Ellrl r6 W F'srira Tor 11 IGMP EVCnT AFT <br /> u 1131,r <br /> swv - rna'YY[hT'S�'l!�'Y!R}'�•'�Mh+R"'^c�'4°I'�.+>nar!.n^'R�I�Fn%yl'Y�'fiC°vSRC;' <br />