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TEMPORARY FOOD VENDOR’S APPLICATION <br />Market on Maple Date(s):1.I.Name of Event: <br />2. <br />Address: <br />( 209 ) 968-0347Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <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 />0 Other (specify): <br />Electricity is provided for my booth's use: Yes 0 No7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APPEHD 16-02 <br />08/01/16 <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 /> Camp stove <br /> Double steamer <br /> Electric 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 />The following is information about my organization/business: <br />BetzysaguasName of organization/business: <br />201 Dorita Way Modesto CA 95354 <br />0 Sterno & hotel trays <br /> Steam table & lids <br />EJ Other (specify) <br /> On-site hose bib that is connected to a potable water source. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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. 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 />* Alternate: ( ) <br />List food to be sold or given to the public <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is frorn^pproved commercial facilities: 0 Yes ElNo z- z. /\/2 | I ‘*7*7 <br />Name of facility: lj Phoned (jO \ / <br />Address <br />I am providing a booth with the following: (to protect my u(yjackaged 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.