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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 />1.Name of Event <br />2. <br />Name of organization/business: <br />Address: 478 Providence St <br />(510 >589-6166Phone:Alternate: () <br />List food to be sold or given to the public: Lemonade3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />7. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APPPage Tcf 11 <br />Tony Fields <br />Market/Sales Manager <br />(209)817-7902 <br />ter to measure the hot and cold holding of potentially hazardous <br />'es No <br />END 16-02 <br />lorisros <br />The following is information about my organization/business: <br />The Lemon Box <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Stemo 8i hotel trays <br /> Steam table & lids <br /> Other (specify) <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^^pproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Sundays Year Round <br />Date(s):ThLjrsdays MaV ‘Nov <br />the festival coordinator three (3) weeks prior to this event. <br />Weberstown Farmers Market <br />Note: Examples of potentially hazardous food include-, <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify):__ <br />Electricity is provided for my booth’s use: Yes <br />I am providing an accurate probe thermonyti <br />foods during all times of booth operation<JjYi <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135-F: <br />I am providing food that is NOT prepared at home: SfYes No <br />All food is prepared on-site or is from approved commercial facilities’® Yes No <br />Name of facility:Phone: (L <br />Address of facility. <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 />4^^ 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.