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COMMUNITY EVENT FOOD VENDOR APPLICATION <br /> PAGE 2OF2 <br /> r YOU ARE PROVIDING A THREE COMPARTMENT SINK,ARE YOU ALLOWING OTHER FOOD VENDORS TO USE YOUR <br /> AEE COMPARTMENT SINK? YES O NO <br /> 23.LIST THE OTHER FOOD VENDOR(S)YOU WILL ALLOW TO USE YOUR THREE COMPARTMENT SINK. (A MAXIMUM OF THREE ADDITIONAL VENDORS ARE ALLOWED) <br /> 1 2 <br /> 3 <br /> 24.IF YO E PROVIDING A THREE COMPARTMENTSINK SPECIFY HOW THE POTABLE WATER WILL BE PROVIDED. <br /> TANK,GALLONS: �(�kC O MUNICIPAL WATER CONNECTION O OTHER: <br /> 25.IFYOU ARE PROVIDING A THREE COMPARTMENT SINK,SPECIFY HOW WASTEWATER WILL BE DISPOSED. <br /> O WASTE TANK THAT WILL BE EMPTIED IN THE SEWER,CAPACITY IN GALLONS: <br /> BE Sl1RE 70 SPECIFY ON THE MAP ANY\I <br /> O MUNICIPAL SEWER O SEPTI JCnglrY TEM ••11 / POTABLE WATER FILLING STATIONS AND <br /> 0 OTHER: ( I taVl L WASTE WATER DISPOSAL LOCATIONS. <br /> 26.WILLANY F ODS BE PREPARED ATANY LOCATION OTHER THAN IN YOUR FOOD BOOTH AT THE EVENT? <br /> YEs Food preparation must be done in a commercial kitchen approved by this department. The Commissary Authorization section below <br /> must be completed and signed by the owner/operator of the approved commercial kitchen where food preparation will take place. <br /> o NO All food preparation will be done in the food booth at the event. <br /> • 27.THE FOOD VENDOR LISTED ON THIS FORM HAS PERMISSION TO USE THE APPROVED COMMERCIAL KITCHEN NAMED BELOW FOR PREPARING AND STORING FOOD <br /> ON T FO LOWING DATE . _ <br /> 28.BU (NESS WE OF COMMERCIAL KITCHEN 29.ADDRE OF COMMERCIAL ITCHEN <br /> • 30.CITY , v 31. 32.Z�� 33.P <br /> 34.FA at�1', C4% 35.OW ER/OPERAjOROFFCOM ERCIALKITCHEN <br /> Qgat 12GJ �IL-Gz/tl.�U <br /> 36a. SIGNED 136b. PRINT NAME 37.DATE <br /> ood Facility Owner, Operatoror Aut or/zed presentative - <br /> I H, E C9 MERCIAL KITCHEN IN ICH FO PREPARATION WILL TAKE PLACE IS LOCATED OUTSIDE OF FRESNO COUNTY,THE LOCAL ENFORCEMENTAGENCY MUST <br /> SIG LOW,AUTHORIZING USE OF MERCIAL KITCHEN,AND VERIFYING A CURRENT PERMIT TO OPERATE. <br /> • 38a. SIGNED 386. PRINTNAME S-k hon%e— Rami,,11 39.DATE <br /> ► Environmental Heath Specialist <br /> 40.COUNTY OF: <br /> I, the undersigned, agree to comply with the Community Event Food Vendor Requirements of the County of Fresno Department <br /> of Public Health. I underst that failure to comply with the requirements will result in reinspection fees being charged <br /> For multiple reinspectio due to uncorrected violations and/or suspension of approval to operate by the Department <br /> Df Public Health. <br /> -1.SIGNED <br /> 42.DATE <br /> Food Booth ner/ perator <br />