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SAN dDAUh 1 k Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All Irxxf vendors 4boih for proof and rlon•profil)are requrn it I-, w1kirn a stitned and completed copy of Ihr-,checklist to <br /> the to%tival ccx nlln,ilnr tflrCC(3)wet%ks prior 10 this event <br /> 1 1.Name of Even f ' / / <br /> Manteca Park-A-Palooza lay=efs,August �, 2023 <br /> 2 The tollowtn a Is rinloirnatxm about my ormantzalrowbuslness. <br /> Namp of org4lnrzafru Vbusurnss <br /> •+uUrt?�� ��4��_� rK'}1Ql��,r±'/�.Q,�_Lt��i..G.�.�_��ll��l��l/,����_j_,��J.G,rR�Pnon£ t.:� J'1 .ar✓�� f. .—..........�._.—..... Alrernatfr.l:.�C 1 : ✓_ ._ l.J. , ` <br /> z�o�� ctaay. ice/ <br /> last tcxw to to sold or glvr3n to[tic public. <br /> �XJl�Qr 9Y/!��%fi�C/fiC�rr� !t✓/i�� S�t~nrer���' Yi/1I.�. <br /> a I am orovicitng food thal is NOT prepared at home:[ Yes No Y/ <br /> AN food is Prepared on site of 6 tram:3nproved commercial facilities:L,Yus❑No <br /> Name of lacilov 1O/J, Phone- <br /> 5 1 am providing a booth with the Inllowing:(to protect my unpackaged food and food preparation areas from flies, <br /> Just and the public) <br /> .j k bwTh with walls and ceiling constructed of either wood,canvas,plastic,similar materktt and line mesh tl,, <br /> screening, completely enclosing open toad areas. It will also have a smooth and cleanable Hoar iconcreie, <br /> asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> 'areas Irum the public 1 <br /> OiherIsUrtrlyl._ I_/' C✓� _ ._.- <br /> Note: Tries only op*%ralurns not required to provide enclosed booths are those which sell barer,lges trorn <br /> approved ctrspenser;,or prepackaged foods from approved sources. <br /> 1 <br /> 6 Appeovea wall.r lot Urinkrng,utensil and hand washing will be provided in my booth by the fvllowrng rnelhod", <br /> r.j Approvt!d buitlwf Vlat(jr <br /> r <br /> i.__I On,site htrse txt)fh.rt v;winodir d to,)poltlblrr w�.ttur SCltfrra- , <br /> 01her(*pPc:rfy) <br /> 7 Elecincity is provided for my txxrEh's ut�eTA Yu::f J No <br /> 8 I am proodrng an accurate prube tttermorneter to inmeiune the hot and Cold holding of potentially hazardous <br /> foods during all tunes of booth operation:XYus�. J No <br /> A I�Fn provr0119[hit foltawlnqmecointrol klr tho hot hotding of all potentially hazardous loads above <br /> 136°F <br /> [J it-3111p stove [}Sterno&hotel Irays <br /> L bouble$learner [J Steam iablo B lidu <br /> Elecvrc stove top Other ispecityl <br /> �op: Examples of potentially hazardous food include: meats, tamales, cooked beans. rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> p i4t:nut I 5locklon. Calilr mia 95N5 I T r.'t19 41 b-3426 F �'09 <br /> Page 4A <br /> i <br /> 1 <br />