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JH11 Jumt4ulfv <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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 this event. <br /> dZZ 7 <br /> 1. 1.Name of Event:91(mkc-�� `Qaiako fa�( Date(s): <br /> 2. The following is information about my organizationibusiness- <br /> -1 <br /> Name of organization/business IlAe, <br /> ell <br /> Address: <br /> Phone: Alternate: ( <br /> 3. :List food to be sold or given to the p blic-,Qatid <br /> Zhee_� =9S... VeygPe,- <br /> 4. 1 am providing food that is NOT prepared at home: es El No <br /> All food is prepared on-site or is from approved commercial facilities: VYes No <br /> Name of facility, Ca V1 Phone: (fjQ) 00 <br /> Address of facility:4WO 11161 h 0a_41Uk!na <br /> 5. 1 am providing a booth- with Wfollowing: (to protect my unpackaged food and food-preparation areas from flies, <br /> 7 d t and the public) <br /> 0 <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 cleanable 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 /> El 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 /> 6, Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> 2/Approved bottled water. <br /> E(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 [I No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: F {Yes R No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> [-1 camp stove P/Sterna& hotel trays <br /> F1 Double steamer F Steam table&lids <br /> F1 Electric stove top 0 Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales.. cooked beans, rice, <br /> vegetables,potato salad, eggs,and dairy products. <br /> 1868 E. Hazelton AveflUe. I Stockton. California 95205 1 T 209 4'08-3420 1 F 209 464-0,138 j wm,,,.sj9ov.org!ehd <br /> EHD 16-02 Page 7 of'I TEMP EVr.NT APP <br /> Mlf4dq <br />