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TEMPORARY FOOD VENDOR’S APPLICATION <br />Market on Maple1 Name of Event Date(s) <br />2 <br />Address <br />( 20S ) 471-4844Phone <br />3 <br />4 <br />N/A <br />5 <br /> Other (specify) <br />Approved water for drinking utensil and hand washing will be provided in my booth by the following methods6 <br />O Approved bottled water <br /> On-site hose bib that is connected to a potable water source <br />urner (speciry, <br />Electnaty is provided for my booth s use Q Yes 0 No7 <br />0 <br />9 <br />meats, tamales, cooked beans, rice, <br />00/01/16 <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 />I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the pubic) <br />the following is information about my orgamzation/business <br />Alma's Sweets & More <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Name of organeation/business <br />3018 Otto Dr Stockton CA 95209 <br />I am providing food that is NOT prepared at home 0 Yes O No <br />All food is prepared on-sile or is from approved commercial facilities 0 Yes O No <br />Name of facility N/A Phone (L <br />Address of facility <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 pnor to this event Thursdays <br />May - Oct <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal 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 />CM liv/Mt u rCv <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 O No <br />Alternate ( ) <br />List food to be sold or given to the public ad xce . CcA-\o¥\ Candj . Cflratwcl