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No. 2854 P. 24Mar. 4. 20 1 6 12:57 PM GHI RARDELL I <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />AH food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />1, <br />2. <br />Address: <br />Phone: <br />ChocolatesList food to be sold or given to the public: 3. <br />4, <br />5. <br />6. <br />7.Electricity is provided for my booth’s use: Yes 0 No <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br /> On-site hose bib that is connected to a potable water source <br /> Other (specify);__ <br />The following is information about my organization/business: <br />Marich ChocolatesName of organization/business: <br />2101 Bert Drive Hollister, CA 95023 <br />83^ 634-4700 <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 />SHO 16-02 <br />11/4/14 <br />Received Time Mar. 4. 20 1 6 12:50 PM No. 0539 <br />I am providing food that is NOT prepared at home: f^Yes EJ No <br />All food is prepared on-site or is from approved commercial facilities; 0 Yes O No <br />Name of facility: Marich Confectionery/Marich Chocolates Phone: ( 831; 634-4700 <br />Address of facility: 2101 Bert Drive, Hollister CA 95023 <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 />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation; Yes [x] No * <br />the festival coordinator three (3) weeks prior to this event. <br />1, Name of Event: Ghirardelli Chocolate Jubilee <br />the hot and cold holding of potentially hazardous <br />Chocolates are at room temp. <br />1 NA9*thChocoiate5 aVe aTroom^em1''01 f°r thS hOt holding of al* potentially hazardous foods above <br /> Camp stove <br />EZ] Double steamer <br />■-■O Electric stove top <br />Alternated 831) 801“5222 Cell <br />1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <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 cleanabie 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 />O'Other (specify); Takes place inside of the Ghirardelli Tent Facility <br />Date(s): Marich 19, 2016