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1 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of ( vent DaWM1 <br />Address <br />( 209 )614 4448 Alternate () Phone <br />3 <br />4 <br />1 <br />5 <br />those which sell beverages trom <br />6 <br />Approved bottled water <br />j On-site hose bib that is connected to a potable water source <br />7 <br />the hot and cold holding of potentially hazardous <br />8 <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />Page / oft I <br />Z Other (specify) <br />Electricity is provided for my booth s use [_J Yes 0 No <br /> Sterno & hotel trays <br />| ] Steam table & lids <br />I ) Other (specify) <br />The foilowi'H] is infomi.ition about my organization/business <br />Cats Macaroons <br />[ J Camp stove <br />Fl Double steamer <br />[J Electric stove top <br />Name of organization'business <br />"4 Sawtooth St Manteca CA 95337 <br />E Yes'^No <br />Phone (___ <br />EHD 16 02 <br />08/01/16 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />.i siqrind and f.omplnlnrl ropy of this checklist to <br />Saturdays <br />May r)ct <br />AU fixxf vendors (txMti foi profit and non profit) are lequnwl to inhiin <br />thP festival coordinator three (3) weeks prior Io Ums event <br />Market on Maple <br />List food to be sold or given to the public Ckx Lr\ 0 <br />I am providing food that is NOT prepared at home^ Yes^No <br />All food ts prepared on-site or is from approved commercial facilities. <br />Name of facility ------------------------------------------------------------------- <br />Address of facility <br />I am providing a booth with the following (to protect my unpackaged food and food-preparat.on areas from flies <br />dust and the public) <br />I am providing an accurate probe thermometer to measure <br />frz/ls during all times of booth operation 0 Yes 0 No <br />I arri providing the following hoi temperature control lor the hot holdmg ot all potentially hazardous foods above <br />135T <br />n A booth with walls and celling constructed ol either wood, canvas, plastic, similar material and <br />srreenma completely enclosing open food areas. If 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 />^.Other (specify) L’X'ilu.'. ------------- <br />Note- The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources <br />Approved water lor drinking utens.l and hand washing will be provided in my booth by the following methods