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TEMPORARY FOOD VENDOR’S APPLICATION <br />May 19-30Date(s):1. Name of Event:1. <br />The following is information about my organization/business:2. <br />Address: <br />(909 ) 986-7502Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br /> Other (specify): <br />beverages from <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APPEHD 16-02 <br />7/14/15 <br />Note: The only operations not required to provide enclosed booths are those which sell <br />approved dispensers, or prepackaged foods from approved sources. <br /> Other (specify): <br />Electricity is provided for my booth’s use: Efves No <br />Name of organization/business: Circo Caballero <br />2534 S. Pleasant Ave, Ontario, CA 91761 <br /> Camp stove <br /> Double steamer <br />?! Electric stove top <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 />A booth with walls and ceiling constructed of either 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) and constructed to separate food and food preparation <br />areas from the public. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by thetfQllowing methods: <br /> Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Circo Caballero <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />+ Alternate: ( 909 ) 730-4272 <br />Hot Dogs, Cotton Candy, Popcorn, nachos, Soda/Water <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No <br />I am providing food that is NOT prepared at home: ^5 Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: Prepared on site t Phone: (1 <br />Address of facility: _ _________________________________ <br /> Sterno & hotel trays <br /> Steam table & lids <br /> pther (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.