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‘ '.9^? -f Date s <br />2 ->?, ng s t’c—at nr abr.(: r-.t- 0-3='' zatinn n jp -rss <br />Uan-e cf D-gamza: cn b„s "•ess SheveUes southern cattish <br />PO Box 828 Lathrop, CA 95330 <br />Pnc"e 471-0656 209 <br />4 <br />O Otner 'scec */> <br />App'oved v.aterfor drink ng uens ard-a-3 .-.as-rg te c-'oviaed h Tty oos:.-, cyt~e'c 3>.-^3 methoss <br />_■ App-oved oo’.fed .vater <br />j On-site hose Pit t-at s connected to a potab e .vater source <br />_2 Other (spec-fy <br />3 <br />r•.' <br />^eirgtratzf <br />e*c tubsX - <br />X <br />J Ref'roe <br />Note: Tne on!y ope-ations not 'equrea to prc.ide enclosed booths a'e those •zhch se be.e-ages ''on <br />approved disperse's or p-eoacxaged ‘oocs **on appro.ea sources <br /> Camp stove <br />C Cc.c e steamer <br /> E er." z stove tcp <br />Addres® <br />x <br />3 Steam :az e S. os <br />!~1 Other 'Spec *y: <br />ice far my booth's use i Yes GlNo <br />Note: Examples of potentially hazardous food include: <br />vegetables potato salad, eggs, and dairy products <br />. NOT C e <br />Ad food 5 o'epared or s :e or is from approved conwnerca faci ties — Yes ~] No <br />Name of faciMy. Phone ' <br />Address of facility._______ _ <br />i arr p'o.'C ng the -g ho' terrpe'alc'e cpr'ml *r !-.e “o: hold 'g all potential, hara-dcus foods adc.-e <br />135T <br />pereture cuntf©: fa; the cod noding cf potentially hazardous foods befaA <br />4./E f faod is used rr.e f: vt :a,’ t?. v-jir Le cw 4' r tempt• jturc.i <br />X ’ ves plastic similar matena and fine mesh fy <br />' -g cor-p -?"o ... - g —•■ •' : i \ . ■ 3 cl • -it .■ <br />asphalt c’ean 'arps a-d smooth -.vom are acceptab a) and ccnst-ucted to seoa'ate food and 'ood cepa'aron <br />3'eas f-om tne publ c <br />“•' ’ooa vendors (txxn prone and -on-c'c'it- are recu red to return a signed and compietea copy of this checklist to <br />’he ‘eshva’ co*-d---a‘r.”"'-?2.3' : ~-s p-mrfath $ • <br />I ar' providing an accurate c'obe the-mome'er to measure tne -ot and ccla '■olCirg of potential / hazardous <br />smes of booth operatfon x -No <br />meats, tamales, cooked beans, nee. <br />L st ‘ccd to re sc d or <br />a.r. prov.dmg a booth with the •'c'.-wrg ;:o p-otect my unoacEaued food a'd fooo f epa ation areas from f es <br />dust ano ire public!