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4. 2016 12:56 PM GHIRARDELLI . No. 2854 P. 20 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event: <br />2 <br />Address: <br />Phone: <br />3. <br />4. <br />Stas'. ^2-^ <br />5. <br />6. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Pago 7 of 11 TEMP event app <br />Received Time Mar. 4. 20 1 6 1 2:50PM No. 0539 <br />EHD 19-02 <br />T 1/4Z14 <br />e- <br />I am providing food that is NOT prepared at home: ^Ves No <br />All food is prepared on-site or is from ap^royedYommercial facilifiesf'Q^es O No <br />Name of facility: IkWWl UVX Phone: <br />Address of facility: ■ <br /> Camp stove <br /> Double steamer <br />- Electric stove top <br />Mar. <br />The following is information about my organization/busmess. <br />Name of organization/business: <br />List food to be sold or given to the public: <br />Alternate: (2zA). M <br />J IX" ^XtjxcL <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 water for drinking, utensil and hand washing will be provlded in my booth by the following methods: <br />©Approved bottled water, <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> On-site hose bib that is connected to a potable water soun <br />O'tSther (specify): <br />Electricity is provided for my booth’s use: Yes [J32No <br />I am providing an accurate probe thermometecdo measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ‘S^s No y <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />f 35 F. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />Q A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />EKJther (specifv):'~Tl<L\/k S,_______ <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator thraa (3) weeks prior to this events > <br />CqItvmCl VksL’