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REC-008 S A NAA R U I N Environmental Health Department t_ CA-1 i*1 I Y TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3)weeks prior to tws event. 1, 1.Narne of Event: �-5�c- in `��g_ �r;c k Juneteentfl S Clate(s): ��_L.I 4 of July Cultural Celebration Light up Main Street 6/15 7/4 7120 8117 9/21 2. The following Is information about(my organization/buslness: 1216 Name of organizationlbusiness: l a��,v____�j� Address: � 15 3 _4��.rut' Phone: 7 Alternate: 3. List food to be sold {or given to the public: 1 ' E��C;�-i+.(11n1 , 5•.,_,tea.-\ \�J�,) rC �,(,tu>\ '4��.. �f'�ltr�tl1 4. 1 am providing food that Is NOT prepared a1 home:❑Yes MNo ! 711 O�cQ 7_ 7 � All food Is prepared on-site or is fronr approved commercial facilities: ❑ Yes�i,No Name of lacil ity: Phone: Address of laclllty: 5, 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) t;�,A booth with walls and ceiling constructed of either wood,canvas, plastic, similar material and line mesh fly screening, completely enclosing open food areas. It wilf also have a smooth and cleanable floor (concrete, asphalt,clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ❑Other(specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged foods from approved sources. B. Approved water for drinking,utensil and hared washing will be provided in my booth by the following methods: j%Approved bottled water, ❑On•slte hose bib that is connected to a potable water source. ❑Other(specify): 7. Electricity is provided for my troth's use.,❑ Yes No B. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation:❑Yes N No Nr 9. 1 am providing the following hot temperature conlrol for the hot hodng of all potonliatly hazardous foods above 1356R. ❑ Camp stove ❑Sterno&hotel trays ❑ Double steamer ❑ Steam table& lids lV//q ❑ Electric stove lop ❑ Other(spocify) Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. ;8M E. Haxollon Avenue 15lackton,California 95205 I T 209 4G8-31I20 f F 209 664.0138 l v�tiv4v.sjtlov.Ulgir:5i�cl EHD 1602 Pnpe7of 11 TEMP EVEN)APP DG.'If3.'I�J 1