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TEMPORARY FOOD VENDOR’S APPLICATION Date(s): 4/28/181. Name of Event: Annual Omelet Dinner1. The following is information about my organization/business:2. Name of organization/business: Escalon United Methodist Church 2000 Jackson Avenue, Escalon, CAAddress: Alternate^ 209) 606-1781 (Jeanette Parsons)838-2792(Phone: List food to be sold or given to the public: Omelets, cottage fries, fruit, biscuits, beverages3. 4. 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Approved bottled water. On-site hose bib that is connected to a potable water source. (NOT A BOOTH EVENT)7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APPPage 7 of 11EHD 16-02 08/01/16 Camp stove Double steamer Electric stove top y Other (specify): Event is hpld in Snrial Hall nf Fscalnn I Inited Mathcidist Church------------------- Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. I am providing food that is NOT prepared at home: [x] Yes No All food is prepared on-site or is from approved commercial facilities: Q Yes O No Name of facility: Escalon United Methodist Church Phone: ( 838-2792 Address of facility: 2000 Jackson Avenue, Escalon, CA 95320 I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) A BOOTH EVENT) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. 209) Q Other (specify): Water is provided hy City of Escalon Electricity is provided for my booth’s use: Q Yes Q No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes No (NOT A BOOTH EVENT) I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Sterno & hotel trays 0 Steam table & lids □(Other (specify) Gas stove