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COU N~ V -• <br />2. <br />Address: <br />Phone:) <br />3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />( 925 <br />Alternate: ( <br />List food to be sold or given to the public: Mel s Awesome Sauce <br />j 852-7174 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />S -enired ,O re,Um 3 Si9ned and “P* <br />1. I.Name of Event: I SLAaIQS Date(s): 4/g?. 11^ Ay <br />The following is information about my organization/business: <br />Name of organization/business: Me, s Awesome Sauce <br />2397 Newport drive , Discovery Bay, CA 94505 <br />I am providing food that is NOT prepared at home:'® Yes No <br />AM food is prepared on-site or is from approved commercial facilitiesYes No <br />Name of facility: Kitchen by the hour Phone* (408 \673"8227 <br />Address of facility: 2365 Tripladi Way, Hayward ,Ca 94S45 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from files <br />dust and the public) <br />C 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 cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />j^Other (specify): Canopy 1 seliing pre Packa9ed f00d_______________________________ <br />Note: The only operations not required to provide enclosed booths are those which sen beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Other (specify):_— ------------------- <br />r^^ovidin^an Ic^urate ^^ teemiometer ^measure the hot and cold holding of potentially hazardous <br />, .xs:; mXXssSxsx <br />135°F: <br />Pl Camp stove D Stemo & hotel trays <br /> Double steamer O Steam table & lids <br /> Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton. Cahfornla 95205, T ^9 468-3420 | F 209464-0138 I —^o^ <br />EHD 16-02 <br />06/29/2023