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P.02~n:05May 27 2015396441931FaSTOCKTON PORTS <br />TEMPORARY FOOD VENDOR S APPLICATION <br />1. Name of Event: <br />2. <br />Address; <br />Phone: <br />List food to be sold or given to the publ3.J; <br />4. <br />5. <br /> Other (specify): <br />6. <br />7, <br />8.neter to measi <br />Eves No <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPsge 7 of 11EHD 16-02 <br />11/4/14 <br /> Camp stove <br /> Double steamer <br />. Electric stove top <br />Note: The only operations not requir Jd to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepac ;aged foods from approved sources. <br /> Other (specify): __________________________________________________________________ <br />Electricity is provided for my booth’s u$i >: Yes lZ^No <br />I am providing an accurate probe ther nometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operat on: Eves No <br />Name of organization/business: <br />______^3 <br />(2^1 ) ‘KhSW <br />Approved water for drinking, utensil ant hand washing will be provided in my booth by the following methods: <br />[pfApproved bottled water. <br />[?fon-site hose bib that is connected ti a potable water source. <br />_________Alternate: ( ^^ ) <br />fihuted, Jal he&MriiMter' <br />EfYes No ■ y <br /> I itemo & hotel trays <br /> jbearn table & lids <br />Either (specify) <br />Note: Examples of potentially ha tardous food include: <br />vegetables, potato salad, eggi i, and dairy products. <br />I am providing the following hot temper sture control for the hot holding of all potentially hazardous foods above <br />135'F: <br />the festival coordinator three (3) weeks prior <br />jL'i/g/Ql i <br />The following is information about my c ■ganization/business: <br />I am providing food that is NQT preparr d at home: 0 Yes No , <br />All food Is prepared on-site or is from ai iproyed commercial facilities: Q^es <br />Name of facility: ________ <br />Address of facility: f <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />A booth with walls and ceiling const xicted 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 />- --------—-------------------No <br />_______ Phone: (2^3) '1^3 ' & 77 <br />All food vendors (both for profit and non-prof t) are required to return a signed and completed copy of this checklist to <br />or d this event <br />Z Date(s); 2Z?/i.5' <br />&>. <br />^7 ------------