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r <br /> S A N : O A Q U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All lord ven"s (both for profit and non-prolit) are requ real to return a signed and completed copy of this checWisl to <br /> lhC Iestnval coordinalor three(3)wee-�ks prior to this event. <br /> 1. 1 Name of Event. Music in the ParlL <br /> 2. The following is information about my organlzalionlbusiniss: <br /> Name of organizationbuslness: Kona Ice <br /> Address: 681 Saffron Drive Tracy, CA 95377 <br /> Phone: 209-597-8760 Alternate_ <br /> 3. List loud to be sold or given to the public. Shaved Ice W <br /> i <br /> 4. 1 am providing food that is NOT prepared at home:R'rsDlo <br /> All loud is prr.- aro on site.or is from approved commerciat lacilitiesR Yesao <br /> Name of fled:ty: On-Site phone: <br /> Address of facility: <br /> `a 1 am providlnq a booth with the following:(lo protect my unpackaged food and food-preparalion areas from flies, <br /> dust and the public) <br /> P'ree <br /> booth with walls and ceiling constructed of either wood.canvas,plastic, similar malehal and tine mesh fly <br /> nmq ccmpintely enclosing open food areas It wil! also have a smooth and cleanable floor (concrete, <br /> asphalt clean tarps and smooth wood are acceptable) and construcled to separate rood and load preparalion <br /> arras lrom the public. <br /> Zzilher(spr-idyl• Refriger ted Truck co a- !sq �zs y <br /> Note: The only operations not requaed to provide enclosed booths are those which sell beverages from I <br /> approved dispensers,or prepackaged loods Irom approved sources. <br /> 6, Approved walrr for drinking.ulensil and hand washing will be provided In my booth by the following methods: <br /> Approved bottled water. <br /> Eln-srm_hose bib lhal is connected to a potable%valer source. <br /> �ther(spicily): Self Contained Water Source <br /> rimly is provided for my booth's use Yr. �/ No <br /> c I zm providing an accurate probe the asure the hot and cold holding of potentially hazardous <br /> foods during all limes of booth operation ✓ Ye o <br /> 9 1 am providing the following hot it mperalu rxttr r the hot holding o1 all polr_ntially hazardous foods above <br /> 5'F: <br /> ,amp sinvrr 134_11hlelmritspecily) <br /> e"no& hold trays <br /> ruble sleamer table 8 lids <br /> lecirir.stovr,•top <br /> Note: Examples of potentially hazardous food include: meats, lamales. cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> f f!4 Fh i Hq_r•!Inn Avr-niir. I Siri4lon.C;.7bfnrnt7 95;'11', T 1 •1,. <br /> rl f1'9 L�7 V+q: '(J <br /> 1 <br />