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Mar. 4. 2016 12:55 PM GHIRARDELLI . No. 2854 P. 18 <br />2. <br />3. <br />4. <br />5. <br />/M <br />6. <br />7. <br />8. <br />9. <br />Include:meats, tamales, cooked beans, rice. <br />Page 7 of 11 TEMP EVE.7T PPP <br />Received Time Mar. 4. 2016 12:50PM No. 05 39 <br />EHD 15-02 <br />Q Stemo & hotel trays <br />El Steam table & lids <br /> Other (specify) <br />Date(s): /l(^1, Name of Event: Ahl' <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are '' <br />the festival coordinator three (3) weeks prior to this event <br />1. <br />the hot grid cold holding of potenfelfy hazardous <br />-No AJ- /\-~ <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />* <50 i - <br />.□ Camp stove . <br /> Double steamer <br />■ O Etecfric stove top <br />Note: Examples of potentially hazardous food <br />vegetables, potato salad, eggs, and dairy products. <br />are required to return a signed and completed copy of this checklist to <br />.irtirr-yiji Chopdrdc At fa Iff, <br />The following is information about my organizatfon/business. <br />Name of organization/business: ~T)<S 'firi-U ChoCfolfl-jc Fuc4n <br />Address: . VlplViskx cm <br />Phone: ( Alternate: (35/ ) 2^6" <br />List food to be sold or given to the public; <br />1 am providing food that is NOT prepared at home: ^Yes O No <br />All food is prepared on-site or is from approved commercial facilities: jfci.Yes No <br />Name of facility; Phone- ( ^ 657 <br />Address of facility; (-faille CM <br />1 ZES Wlth the fol,owir'9: (t0 my unpapkagad food and food-preparafion areas from flies, <br />2eI061!?9 ®'ther wood. canva5, plastic, similar material and fine mesh fly <br />^clos"19 °Pen f00d areas- V'i’l also have a smooth and cleanable floor (concrete <br />ZZXXc S acceptable) and constmcted to separate food and food preparation <br />Other (specify):(2Li■ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved wafer for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source <br />, Other (specify):_________ ______________ <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to <br />foods during all times of booth operation: O Yes