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Rug 10 2010 11:02AM r’nM0US DAVES TRACY 20'" 161075 P- 1 <br />Aug.OS,2010 03:40 PM PAGE.8/ 10 <br />FOOD VENDORS PERMIT APPLICATION <br />1. <br />2. <br />AdtlrseB; <br />Phone: <br />3 Liet food to be sold or -given to the putMic. <br />4. <br />6. <br />those, which «ell bewray from <br />6- <br />7. <br />a hazardous <br />9.above140’F: <br />'TTZ^vck <br />rice, veflettl , potato <br />p»g*rof9 TEMP EVENT AFP <br />The following le ifrfbrmaticn about mycrganlzaUon/businMa: <br />Name of ofsanlaation/buelnBss. c><^ S _£> J <br />zV- /gJ. <br />A5 food vendors (both for profit and non-profit) are required to return a signed and completed copy of this :hacMI»t to <br />A^Oatefe).- 7~ <br />jp / <>4- <br />)_______ <br />y T <br />the fwttvai organizer two (2) wweke prior to thts event. <br />Name of Event' <br />3 /V- <br />^337_______ AHemsrteU <br />A^\c^ <br />I »m providing foods that ant not homemade: <br />All toodi ere prepared on-sfte or are from approved comtnercial fadfitiesi^Ef^e No <br />Name of facility: X4?<Q Phone: <br />EH Permit#; 9 9 <br />Hrnp^iddlng my unpeckagad food and food-preparation aroes from files, duet and the public by tl« following <br />xR(a booth with wans and celling constructed of elfrier wood, canvas, plastic, similar material end flu* mwn try <br />-screening, compfotoly enclosing open food areas. <br />0Ahaam with a smooth and cleanable floor (concrete, asphalt, dean tarps and amooth wood are eccepteWo). <br /> A booth conaitucted to separate food and food preparaflon areas from the public <br /> Other (specify): . _________ _____ <br />Note: The only operabonc no| required w provide ancfowd booths are <br />approved dispensers, or prepackegad focda from approved sources. <br />Approved water for drtilclng. utenail end hand washing will be provided in my booth by the following Aiothodt; <br />/Approved bottled water (Alhambra, Polar, Sierra Spring, etc). <br /> Hose-bib on-$Jte at the fattlvei, <br /> Other (specify): „ __________ <br />Bwtritity ie provided for my booth's use; Ye*^ji)[p <br /><-^2? l5oiSntlJr' probe thermarnetor to measure (he hot and cold holdng of potentiallj <br />foods during afl times of booth operation: 2j*esD No w H ' <br />lam trntding the foltowing hot temperature control for the hot holding of all potodlalfy hazardous foxte • <br />-fU, <br /> Camp stove Q Stamo & hotel trays <br /> Double steanw TMm ftrtfe & Ikfe <br /> Eieetrio stove top ^ther (specify) <br />Noto: Pctantlaity hazardous food exampfoa: mails, tamales, cooked beans, <br />salad, eggs, and dairy products. <br />£HD 18-02nnam