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Environmental Health Department
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<br /> TEMPORARY FOOD VENDOR'S APPLICATION
<br /> Alt fbcad venti(jrq{hz:th ttar pront rind non•prulil).nro roqulrt;d to rolurn a signed uou coraaplatod copy of Ili I!;cht.-Wit.t to
<br /> It";Ifmfivral eeordirintor thrao(,a)weekn prior to this ovont.
<br /> II 1 i Nnnze(if Fveni: ' Manteca Park-A-Palooza Duto ')'
<br /> tion nbout my organuatlonlbusfnoss:
<br /> Naama of organt<aGcrrlbminess' Flip N Fry Mobile Calering
<br /> Address: 3933 Shody Oak CII, Tiirloek, CA (Will?
<br /> Piano: ( ?(N) ) 277-624S _— — —- Altarnato:( )— -- -
<br /> 3. List fond to be sold or given to the public: I fill tttttr roil V ,Liu taltics, Frics,Loaded Frica,Canned:,oda, ot
<br /> tall tic water
<br /> 4, 1 am providing food that is NOT Prepared at Home:6 Yes❑No
<br /> Alf food is proparea orr•sito or Is from approvoci commorcint fncltitlos:29 Yes❑No
<br /> Name offacillty: 1-a Comis:ari'a Phone: ZfI 19 1331i-3663
<br /> Address of facility; 1211 S 7th 5t. Modesto, CA 95351 -
<br /> ti, I rim prcvicinp a booth with tho following:(to protect my unpackarged food and food-prnpa ration proms from
<br /> dint and[tie public)
<br /> 0 A bncth tsivi .voliq.inn tailing Constructed of aifharwood,canvas,plastic, similar material natd find mi;sla fly
<br /> ,screening, completely enclosing open food areas, It will also have a smooth and cluanablo floor (cencra•1t,r,
<br /> a,shalt. cfejri tarpc Rind smooth wood aro necoptoblo)and conatnrclod to soparato food orad food proporntion
<br /> areas trorn the public
<br /> 'K'Gthcr(spatafy): i:ncloscd mobile Band trailer
<br /> Nato, The only operations not required to provide enclosed booths are those which soil bevera„os from
<br /> approved ecispc+nsers,or prepackaged foods frnrn approvtari sourcri4
<br /> r Approval winter for drinking,utensil and hand washing will bs provided In my booth by tho fofluwirig nmthods:
<br /> i,_i.r,;;rroveC hnftlf;:1 vlalt:r.
<br /> ,,.:,•sit,i f c++;1%that Is mrinected to a pulabio watts source.
<br /> tiCif-catuttilicd haattablu wtatcr tank.
<br /> i; ,J for my booth's usca: Yeas,(]No
<br /> �rat.3 probe InoIrmorQqIor to monstiro tho hot and cold holding of potcnllaily hnznrdnur;
<br /> I';;.:of booth oporailrin Yes 0 No
<br /> I ,,vinq hint tcrnpora[tire control ftsr titre clot lrnldln(l of J1 potenfiAly hazard us forrci,nt�rr:rf
<br /> I I
<br /> [I Stem()&hotel lrays
<br /> l:i •: n,,,, [ Stoam tablo&11dn
<br /> -]rAhor lsaccity)
<br /> +-Ksfr}Plc, of potentially hazardous food Include: meals, tamales, cooked beans, rice,
<br /> J, ctt*.aWes,pol;sta salad,eggs,and dairy products.
<br /> C,•afifom(a 952051 T 200 afi8-Mo 1 F 209
<br /> 1 Z5s_�Twy r,�. Rh
<br /> ,r nfirirvrp rkt,r,rr
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