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520986218? TEMPORARY FOOD VENDOR’S APPLICATION 2. Cr^YW Addrosa", 3, 4, 5. i0. 8. 0. meats, tamales, cooked beetle, rice, TEMP EVENT APPPnoa? ol11 I I Mar. 4. 2016 12:54PM Fab.24.2016 01:04 AM Sterno & hotel traya Steam table & llcfe Other (specify) EHO 10-0? IIM/14 Received Time Mar. 4. 2016 12:50PM No. 0539 P uiZGHIRARDELLI CRFudg No. 2854 PAGE. I I I I Phone: List food to be sold or given to the public: I am providing food that la NOT prepared at home: O AB food la prepared Name of facility: J Phone: f-^/) AZI foods during all times of booth operation; O YetuEl No I am providing die following hot temperature control for (he hot holding of all potentially hazardous foods above 13S’F: .□ Cemp stove Double steamer " Elsotrfe stove top Note: Examples of potentially hazardous food Include', vegetables, potato salad, eggs, and dairy products. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this cheokllst to the festival coordinator three (3) wep,l$B prior to this event, , I, Name of Event: ^5^ ukA Q\\\ e U i .1 t&Ss): ( The following Is Information about my organIzatlon/bualness: Name of organlzatlonfbuBlnesa: _Q iJQLx_V La (A Cjj2—YYVP-^.C) Oy\Y\f\£AifV\ CYl. "T/’dt \ \ )(4TZL/i <2o%) - .. . C&- , Altarnats: VuAcj^ Ccm&cj ____________ . .^^No I crFelte or le from approved commercial facilities RM Yes No C,, Address of facility: n c^\ 'T^a. A I am providing a booth with the following: (to protect my unpapkased food and food-preparation areas from -files, dust and the public) A booth with walls and celling constructed of either wood, canvas, plastic, similar material and fins mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood ara acceptable) and constructed to separate food and food preparation areas from the public. □ Other (specify): . /S ’ Q V ------------------------------------------ Note: The only oparatlona not required to provide enclosed booths ere 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: Approved bottled water. On-site boss bib that Is connected to a potable water source. , □ Other (Rpnolfy): j\!__fl^.C, K Aygrl-------—-------------—-----------— 7, Electricity Is provided for my booth's use: Ysaj^J No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous