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Feb. 5, 2016 4: 20PM No, 4522 P. 5 <br /> TEMPORARY FOOD VENDORP8 APPLICATION <br /> All:food vendors (both for profit and non-prof1f),are required to return a signed and completed copy of this checklist to <br /> the festival coordlnator three(3)weeks prior to ttifi§:Qvent; <br /> 1. 1.Name of 5verltS �Dl W NAND 1 Dap FAST VAL Date(s):6H'RIL 2,2016 -- <br /> 2; The following Is information about my or�gtpnllziationlbus1h6ss; <br /> Name 6f grganizatlonlbusihesg; FA ^�' ' <br /> Addressi 17 5 L,66( SL­4 c4 q5 yo <br /> 7,6_4 7 p <br /> 3: <br /> Lia t foi?d la.be.:�old or given to the public; H►t,(Alc�crrr f�rtg.( /v✓✓,'�� �+�I+:..tie%�. ���ln.fr <br /> 4, lam prouidlho fbod thot$.NOT'prepared at home: H Yes 0 No <br /> All fopd`s:pfeoof�d,dn4lre:anis tram approved commercial faoffltiew RrYes C1 No. <br /> N.�mp Qf:facllify: �O�I�O�A'as=FESTtv,4L Ftione,;¢z08 <br /> Ad*e'kof P ciGty 4 1=.obl<6FO. D STREET..LODI cA 058o <br /> 5, <br /> l am.provlding.a bfapth wltft the fpllowing:(to protect my unpackaged fold and fvoti�preparetlorl„al`i�a ftQn1 files; <br /> apd ttfe.'pufallo): <br /> JOA-1566th Wltf' wall0.and belling constructed of eith6r woad, cah14%p...las)ic,Ar-Olar m0W.14l and fine.meah y <br /> screening., atatTipintEl)i ehciiising open-food areas. It 011 also hate a $r�1ootfl:and oieenabl® floor (cQngrcte; <br /> aspha(,t,clean tarps and smooth wood are aocoptable)and 666'tructed:to separate food and footl preparation <br /> are2a from the ppblic' <br /> NgEe :only: operations not required to,provide' enclas,ed`pogttis are. tho p'which spU'MVeragss from <br /> 7I1e <br /> 0pproved dlspeh: ers,or prepaokaged foodjram op"o aved Sggrces;, <br /> 6, Approved W40r for drinking, utensil and hi.#W WOO 4h will.b prpvided j f7 riiy booifi.by.th$following methods; <br /> ®APptoved bottled water, <br /> 0:6.h4ite hose.blb'thet is Gannectad to a potabloWolter'sourpa: <br /> d Other(specify): — <br /> 7 EjeFtrioity'is prpv'tded for my booth's use;.M Y6s d.Nd <br /> B. I.ari`r provld(t1g en,, ccilwe probe theftometof:0 MbftUre t<Fti6:f5ot and.cold hijltling of potentially haiardous <br /> to durjiip 611 times of booth operation:®.Yes ff$o <br /> 9 f am proVldltig the following hot temperature control for the.hot Hotdln bf all pat®tltlally tiezardous foods above <br /> Gamp:;M 0 ❑Sterno&.hotel tMYS <br /> �'.06L.6steamier Steam tab <br /> [ te le&fids <br /> let;tr)c stove top. Ej Other(specify) <br /> Note: O'>Sattt'ples. sof ppf6htiaity Hazardous food Include: meats, Umalesi 'cdglted Cfear9s ride; <br /> vedbia.616t,potato$aladf eggs,and dalry produets, <br /> ENo 1"2 Papa 7 011 TEW-EVENT Af <br /> 7l1 aM$' <br />