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C1t9E�14Y— _ <br /> �.. 4 ra„> <br /> TEMPORARY FOOD VENDOR'S APPUCA B ION <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 .s event. _r <br /> 1. 1.Name of went: <br /> 2_ The following is information about my organization/busimess: G <br /> Name of erganizationrbusiness: J,!lG- 7l iwl <br /> Address: (CJ /_5 <br /> Phone: ) C Altemate:( } <br /> 3_ fist food to be sold or given to the public %���( L n3 _ <br /> 4_ 1 am providing fond that is NOT prepared at home:t<Yes F] No <br /> All food is prepared o -si#�or is frorr3 ap roved co merci facilities:, jYes No <br /> Name of facility: Phone ( ) <br /> Address of facility: _..._ <br /> 5_ 1 am providing a booth with the following: (to protect my unp2Ck2ged food and food-preparation areas from flies, <br /> dust-mod ffra puW.) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic,similar material and fine mesh fly <br /> screening, completely enclosing open food areas. It will also have a smooth and clearable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> Other(specify): _.r I 111 I_, <br /> M e only operations not required to rovid�l sed booths are those which sell beverages from <br /> Mote, �h Y P q p 9 <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_ <br /> D Or si�e fu3se bk�tip�z a wcsect=-d to a patRh'e w r su� <br /> 0 Other(specify): <br /> 7_ Ekxtimly is provided€o,=my booth's use:Q Yes Lj No <br /> 8- 1 am pra'—Kxv an aco a paln b3 at a ffTe ell a=CMU rdk'�_q rw ps' <br /> fbcds during ak farm oa bcxbt off--_mrL YL-,-D Wo �� <br /> Q_ 9 a rn prmidsnn tt-,e feD� hot ten4XHa�e Dolt, faT ate trot t��of aE��1�� f=As above <br /> 135`F: <br /> Ej camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&Cds <br /> E ric sfave top ❑Other cspecsfy) <br /> Dote: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-342C I E 209 464-0138 1 vavrw.sjcehd.corn <br /> F80 16-C-2 page 7 or 11 -Fe,.P SVr:Nr APP <br /> 07i3[17 <br />