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SAW JUAQ <br /> CD�_5 r"I'l-} Department <br /> 1, <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for prof[t end non-profit)nra required to return a signed an campleted copy of this checklist to <br /> the festival coordinator three(3)weeks Prier tri th«o„o t <br /> i I_Narne of Event: ' �t/rvt ,r - �/ -2 S- , <br /> - - - - late(s):_r <br /> 2• The following is information about my organizationlbusiness: <br /> Name of organiz�attion/business: <br /> ZcT/ f 1 <br /> Address: <br /> Alternate: ( ) <br /> 3- Dist food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home:LH`Yes[] No <br /> All food is prepared on-site or is TASP <br /> from approved commercial facilities:Name of facility: r des❑ No <br /> r� Phone:�rQS <br /> Address of facility, � 7 3� <br /> • la providing a booth with thE:'fallowEn to rotect my u packaged food and food-preparation areas from <br /> �du�st and the public) 9 ( P flies, <br /> 2'A booth with walls and ceiling constructed of either wood, canvas Plastic, <br /> screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (c❑ncre elar material and fine mesh y <br /> asphalt, clean tarps and smooth wood are acceptable)and constructed to separate food and load preparation <br /> areas from the public <br /> ❑;Other(specify): ; / •�►� <br /> Note: 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 /> a. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> U�pproved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7. Electricity Is provided for my booth's use: Yes No 8. 1 am providing an accurate probe therrnomee measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation; Yes❑ No <br /> 9. l aril providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> a p stove tem❑&hatef trays <br /> ouble steamer ❑Steam table&lids <br /> ❑ Electric stove top ❑Other(specify) <br /> dote: Examples of potentially hazardous food include: meats, tamarps, cooked boan�, rico, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 9868 E. Hazatton Avenue l SYncktart, California 95205 I r 209 4i?$-342b 209 464-0138 I tuww.sjgay.org/ehd <br /> 18 16t12 <br /> n6l1 sli 9 Page 7 of 11 TEMP EVEhT APP <br />