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4. 2016 12:56 PM GHIRARDELLI No. 2854 P. 22 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event: Date(s):March 19, 2016 <br />2.The following is information about my organizatic <br />Name of organlzation/business: Fab Delights Chocolate Truffles <br />3718 cascade ct Antioch, ca 94509 Address: <br />Phone:) ^384195 ) <br />3.Id or given to the public; <br />4. <br />3826221 <br />5. <br />Everything will be prepackaged <br />6. <br />7.Electricity is provided for my booth's use: Q Yes Ex No <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Paje 7 of 1 i TEMP EVENT APP <br />Note: Examples of potentially hazardous food include; <br />vegetables, potato salad, eggs, and dairy products. <br />Approved waterfor drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />EJ On-site hose bib that is connected to a potable water source. <br />0 Other (specify):__________________________ <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> Camp stove <br /> Double steamer <br />□•Electric stove top <br /> Alternate: ( <br />Chocolate truffles <br />EHD 15-02 <br />11/4/14 <br />Received Time Mar. 4. 2016 12:50 PM No. 0539 <br />925 <br />List food to be <br />Ralphs kitchen & catering <br />71 SAND CREEK ROAD #C <br />—Brentwood, ca 94513 <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 />Mar. <br />OH Other (specify): <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 />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />1 Pr°v'd'n9 the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 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 />I am providing food that is NOT prepared at home: Lx Yes No <br />All food is prepared on-site or is from approved comn ercial facilities: Lx Yes No <br />Name of facility: Ralphs kitchsn & catering Phone: I_925 ) <br />Address of facility:. <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 three (3) weeks prior to this eve <br />1st Annual Chocolate Jub