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o- <br /> S A J OA O U IN Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both Ix profh and Mort-profit) are required to return a sigr*ed and compte+led copy of this cheditisi to <br /> the festival coordinator three(3)weekWior to this ev <br /> 1. 1 Name of Event: <br /> Z. The following is information about <br /> my vDanizatlonolbusrt <br /> organizatfonlbusiness 'J �'�~tJ� fts <br /> `1 `'a�' <br /> p 1 tt t-h q 15 3Y <br /> Address. hAn ) r <br /> Phone: (OV11i { �P� Alternate: <br /> 3. List jp!!�40?e s ive_n_1Q1h u �rE•� .� Pt-,) <br /> ZK rl <br /> 4 1 am providing L that is NOT Oared at home ❑ W <br /> All food is prepared on-site or is from approved commercial facAllies: El Yea❑ No <br /> Name of facility. Phone: f ) <br /> Address or facility <br /> 5. 1 am providing a booth with the fotomng: (to prole,my unpackaged food and food-preparation areas from flies. <br /> dust and the public) <br /> ,4 booth with walls and ceiling constructed of ether wood, canvas, plastic, similar materiel and fire mesh fly <br /> screening. completely errGosing open food areas. It wrs also have a smooth and cleanable floor (concrete. <br /> asphav, clean tarps and sn>K?41h wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> ❑Other(speedy): <br /> Note: The only operations not required to provide enclosed booths are those which eel teverages from <br /> approved dispenses or prepackaged foods frem approved sources. <br /> 6, A)vcived water fcr drinking, utensil and hand washing will be provided in my booth by the foaawing methods: <br /> djAAvproved fettled waver. <br /> #10111-s4le"e bib Thal is conneded to a potable water source. <br /> ❑Other(specify.l: <br /> 7, Elecfncity is provided for my booth's use:JZ Yes ❑ No <br /> 8. 1 am promd,ng an accurate probe thermorriqlar to measure the not and cold hoileg of potentially hazardous <br /> foods during A tines of booth operation: ❑No <br /> 9. 1 am providing the followng hot temperature control for the hot hold"of all potentially hazardous foods above <br /> 135'F: � <br /> ❑Camp stove ; fftmo&hotel treys <br /> ❑Double steamer ❑ Steam table&lids <br /> ❑Electric stove top ❑Other Ispecify) <br /> Nab: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegtMbles, potato salad,eggs, and dairy products. <br /> 1�E-r __ razelton Avenue S,acvtoir1, iCaliforn.a 4S_U_ T 2J9 468-'4 li , F 1�j4 4(,� .iA IN%Vb4 5]Jv CrC'rr,' <br /> EHD 16,02 rEt1'WW3 fEYP E'oENT APV <br />