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R EC-OO B <br /> ,BAN JOAQUIN � � � �,p <br /> �i(-II�/�i'��'���f�,rf����� ����iAfl�b,�`d Department <br /> artment <br /> { t.1 NI'`i <br /> i <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.Nam Kite FestivB e of Event:_ __ I]ate(s): 5/ 7 f2— <br /> 2. The Iollowing is information about my organizalionlbusiness: <br /> r p ! <br /> Name of organization/business: �-`V—"e.1.J (� -- <br /> Address: f /V Ah JeV <br /> I <br /> Phone: -2-,7 Z (p`�� Alternate: P <br /> 3. List food lobe sold or given to the public: <br /> 4. 1 am providing food that Is NOT prepared at home. es 0 <br /> All food Is prepared on-sfte or is from approved commercial facllilles:�ges[]Na <br /> Name of facility_ S`�c�c.�� l�h Ccrn��r�h l e-Aeh Phone: �t'�� 2-1���� <br /> Address of facliily: )(t� N 1 >`�/�Ivly SF. sa�.k!-:�, C<:� ?_ zvz_ <br /> 5. 1 am providing a booth with the following:(to protect my unpaokaged food and food.preparation areas from flies, <br /> dust and the public) <br /> i <br /> 'booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> ening, 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 i <br /> areas from the public. <br /> �ther(specify): j <br /> Mote: 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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> approved bottled water. i <br /> fan-site hose bib that is connected to a potable water source. <br /> 7, Phor(specify): <br /> eolirlicily is provided for my booth's use Yes No <br /> f3. I am providing an accurate probe the asure the hot and cold holding of potentially hazardous <br /> loods during all!Imes of booth operation - Ye o <br /> 9, f am providing the following hot temperalu ntr the hot holding of all potentially hazardous foods above <br /> 5"F: <br /> 'arrlp stove terno& hotel frays <br /> E <br /> [3oublie steamer �ieam table & lids <br /> letr0 stove top Other(specify) <br /> Note: Examples of polenlialty hazardous food Include: meats, tamales, cooked beans, rlce, <br /> vegelables,potato salad,eggs,and dairy products. <br /> 1861) I.:. H,azelton AvonM I Slookton, California 052051 T 209 466-3420 j F 209 464-01013 j www,sjgov.ortllchd <br /> EHO 18-02 Page 7 0111 TEMP EVENT APP <br /> 0W19:19 <br />