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2017-05-05 17:36 Jei dahh Inc 1209 SJC HSA P 1/2 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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 event. <br /> 1. 1.Name of Event: `''WW 7(r,M W Date(s): <br /> 2. The following is information about my organization/business; <br /> Name of organizatlontusiness; c�.Qy]p VVM `r,, <br /> Address: �7�i 'E. hu r <br /> Phone: (�a�) �� � 76 Alternate:( ) <br /> 3. List food to be sold or given to the public: Y rp as (p , y/6-p9 e Bfa cltiyp cv►w <br /> 4. 1 am providing food that is NOT prepared at home:(Z Yes❑ No �o � <br /> All food is prepared on4te p <br /> or Isfrorn approved commercial facllltles: Yes❑ No <br /> Name of fadlity: � ? f Le., 9K472t�fi� Phone:(2,-h ��55 O807 <br /> Address of facility: �Q5? VYR� Ln <g+,P0 nM C/# 9�7,.� <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from files, <br /> dust and the public) <br /> XA booth with wells and calling constructed cf 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 /> ❑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 /> G. Approved water 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 /> 7. Electricity Is provided for my booth's use: X Yes❑No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:PQ Yes 0 No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135"F: <br /> �►Camp stove X1 Sterna&hotel trays <br /> l Double steamer ®Steam table&Ilds <br /> EZ Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Includo: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> CHO 1t.02 P"7 or 71 TEMP EVENT APP <br /> rn,r1 a <br />