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TION Date(s):Holiday Bazaart.Name of Event:1. 2. Address: R38-279?,(209 )Phone: List food to be sold or given to the public:3. 4. 5. 6. Q Approved bottled water. 9. SFP 2 s 8. 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. Stemo & hotel trays Steam table & lids 0 Other (specify) Gas Stove meats, tamales, cooked beans, ice, 1868 E. Hazelton Avenue | Stockton, California 95205 | 209 468-3420 | F 209^^1^ 07/3/17 EN, ... ...Th PtMH i > ot_r\ v i^lS The following is information about my organization/business: Name of organization/business: Escalon United Methodist Church--------------------------------------- -------------- 2000 Jackson Avenue, Escalon. CA______ _____________________ _— Alternate: ( 209 ) 606-1781 (Jeanette Parsons) Soup, bread, pie, beverages I am providing food that is NOT prepared at home: SI Yes No All food is prepared on-site or is from approved commercial facilities: S Yes No Name of facility: Escalon United Methodist Church Phone. (209) 838-27.92------------------- 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. px| Other (specify): Event is held in the Social Hall nf Escalon United Methodist 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. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: \'5 On-site hose bib that is connected to a potable water source^ ■'2-czC' ' (x| Other (specify): Water is provided hy City of Escalon----- ----------------------------------------------------------- Electricity is provided for my booth’s use: O Yes Q No NOT A BOOTH EVENT I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: O Yes O 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: Camp stove Double steamer Q Electric stove top Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Greatness grows TEMPOrJRy FOOD VENDOR’S APPLI