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1 N.im( ,'f I vi nl <br />Address <br />Phone <br />S Other (specify) <br />Approved water for druikinp. utensil and hand washing will be provided in my booth by the following methods <br />O Approved bottled waler <br /> On site hose bib that is connected to a potable water source <br /> Ollier (specify) <br />Electricity is provided for my booth s use Q Yes No <br />■ following hot temperature control for the hot holding of all potentially hazardous roods above <br />meats, tamales, cooked beans, rice. <br />■ ’iT - <br /> Stereo I1, hotel tray. <br />[ | 'tteani t.ibl<' A li !■. <br />| | (>11 >i -i (■ p< •< ity) <br /> < amp sir>vi ■ <br />(3 I Joubli '.t' nni -i <br />Q I let trie 'Jovi ■ irq' <br />run re o/ <br />•rm i- <br />I irii providiiiij tin <br />1 “ I <br />O 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 and food preparation <br />areas from the public <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products <br />(NO mils)____________________________________ <br />Note: The only operations not rc^^red to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />i <m providing jn accurate prob’ Ihcmnometer to measure the hot and (.old holding ot potentially ha/ardoc - <br />foods during all lunes of booth operation YesO No <br />h, followinc] is information about my organization/busrness <br />Name of organization business OAVflrr SEAFOOD <br />3436^ CIRCLE t t <br />15101 gqi- faqgq-Alt(?rnato ( <br />st food to be sold or given to the public WHOLE F|5HJ PIU-€TS ; OYSTEP S ;(2MAfS; <br />I am providing food that is NOT prepared at home (3 Yes No <br />AH food is prepared on site or is from approved commercial facilities [xl Yes No <br />Name of fa ________Phone {_____i______________________ <br />Address of facility _ PlEP, M-5 | SflN ffiAMCtSCO. CA___________________________ <br />l am providing a booth with the following (to protect my unpackaged food and food preparation areas from flies <br />dust and the public.) <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the mJn?1.!"11"' ' l|" P'0*11 uini non profit) an' rr'gum'd to return a signed and completed copy of this checklist to <br />,l11 '‘stivalioonfmator thus'(.<) wtrnks poor io this event , I / <br />(//« _ 1'/» h 2 <br />PdyeR. (J.,fc(S) <br />8 30 -12’30 r