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4/24/2018 Stanislaus County Health Permit 2.jpq <br />Page 2 of 2 <br />o □ NO <br />o <br />o <br />■ <3k<So <br />Food ltem(s) <br />CsIA <br /><&■ <br />J <br />Imany people will be working in the booth?Hi <br />4-z4-ieOperator's Signature: Date. <br />G:\APPL\lntemal Documentation\Heat\wo190044 TFF Application - English revised 2014.doc <br />1/1https://mail.google.com/mail/u/0/?tab=wm#inbox/162dbd6b604cb36e?projector=1&messagePartld=0.1 <br />YjdAcV <br />Does any food contain meat, dairy or cut fruits or vegetables? <br />Will all food and drinks served be prepackaged? <br />Will all food be prepared at the temporary food facility site? <br />What is the amount of time used to transfer the food to the event: <br /> List all food items, including drinks, <br />Cooking Method <br />(ex. fried, grilled, baked) <br />^YES <br />^YES <br />□ YES <br />□ NO <br />(Xno <br />Where is food <br />purchased /obtained <br />Holding <br />HOT or <br />COLD? <br />Name of EQUIPMENT <br />used for hot or cold <br />holding <br />ko Ld___ <br />Vxx vA <br />(CA <br /><yc*x<vd. <br />. - o?w4 <br />4 62.5 3; <br /><34*4ixd* toe <br />f/A <br />minutes/hours <br />ice, and prepackaged foods such as chips or candy. <br />'G.bV 4x^5 <br />CSV\ I c<_ <br />Sketch Sheet - In the following space provide a drawing of the food booth. Identify and describe all equipment, including <br />hand-washing facilities, dishwashing/utensil-washing facilities, cooking, hot-holding and cold-holding equipment, prep <br />tables, food storage, and garbage containers. ) ____________________________________________________ <br />/, Ad/AcKvywL , ha ve read the TFF guidelines and understand what is expected of me in order <br />to operate my temporary food facility at this event. If I fail to provide the required items during the operation time, it may <br />result in suspension/revocation of my permit, or further legal action.