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Mar. 4. 20 1 6 1 2:52PM GHIRARDELLI No. 2854 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2- <br />Address'. <br />3. <br />4. <br />5. <br />6. <br />8. <br />Q. <br />meats, tamales, cooked beans, rice, <br />PagaZoril TEMP EVENT APP <br />Received Time Mar. 4. 2016 12:50PM No. 0539 <br />EHO 16-D2 <br />11/4/14 <br /> Camp stove Starno & hotel trays <br /> Double steamer Steam table & lids <br />" Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 provided in my booth by the following methods: <br />^0 Approved bottled water, <br />L J On-3ite hose bib that is connected to e potable water source. <br />O Other (specify): <br />Electricity is provided for my booth’s use: YesPTNo <br />I am providing an accurate probe thermometer to measure ths hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes^S^fo <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />f. 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 priorto this event. <br />1. Name of Event: iJLjWu&L^ff dwpUk Date(s): <br />The following is information about my organizetion/business: <br />Name of organization/business: /ViAm’S TnrestoT’U-A <br />. 11^7 W-tolpto PA- ffaiy <br />Phone: Alternate: ( ) (o ~~ S/ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: Yes<^No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes No <br />Name of facility: __fWV\ft5 'PcrgnTSK ^^ Phone: (ftO^) <br />Address of facility:.!tU’ <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 a'nd food preparation <br />areas from the public. <br /> Other (specify);'