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I <br />TEMPORARY FOOD VENDOR’S APPLICATIONI <br />Market on Maple Dale(s)1.1 Name of Event <br />2 <br />Address: <br />3. <br />4. <br />5. <br />I <br />6,Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />I <br />Jt-V WJWI||H|»II ■ <br />I <br />1 <br />I <br />I <br /> Camp stove <br /> Double steamer <br /> Electnc stove top <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 />Name of organization/business <br />1400 Divine Lane Tracy CA 95376 <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />The following is information about my organization/business <br />Jill's Fruit on Top <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 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 />L2 Other (specify): ihlU <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (lx>th for profit and non-profit) are required to return a signed and completed copy of Ihts checklist to <br />the festival coordinator three (3) weeks prior to this event Saturdays <br />May-Oct <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> On-site hose bib that is connected to a potable water source. <br />0 Other (specify): IE)1 IV-idA 2iVli\ <br />Electricity is provided for my booth's use: Yes 0 No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No <br />Phone. ( 209 } 660-0227_________________ A|(ernate ( £t7| } 2 P/ -(/^// <br />List food to be sold or given to the public: l^<|i(U) iH * | ll/ip/E'| <br />I am providing food that is NOT prepared al home:^Yeti[/j No <br />All food is prepared ^n-sile or is from approved commercial facilities 0 Yes Q No <br />Name of facility:Phone: ( ) <br />Address of facility:_