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Date(s):July 22, 20171. Name of Event: Mega 100 Summer Jam1. <br />The following is information about my organization/business:2. <br />Alternate: ().) <br />List food to be sold or given to the public: TACOS, QUESIDILLAS, NACHOS3. <br />4. <br />1 <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />X <br />On-site hose bib that is connected to a potable water source. <br />Other (specify): <br />NoElectricity is provided for my booth’s us^]7. <br />8. <br />9. <br />TEMP EVENT APPPage 7 of 13 <br />□esX No <br /> Yes No <br />Phone: (___ <br />I am providing food that is NOT prepared at homd <br />All food is prepared <br />on-site or is from <br />approved commercial <br />facilities: ---------------------------------------------- <br />Name of facility: ON SITE <br />Address of facility: <br />EHD 16-02 <br />08/01/16 <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from approved <br />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 <br />flies, dust and the public) <br />I am providing an accurate probe thermoi <br />foods during all times of booth operation^ <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />iter to measure the hot and cold holding of potentially hazardous <br />fes rd <br />iPORARY FOOD VENDOR'S APPLICATIOi <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. <br />\!ZJ Approved bottled water. <br />Name of organization/business: Dwight Johnson Scholarship Foundation 6333 Pacific Ave #316 Stockton, Ca <br />95207 <br />Address: <br />( <br />Phone: (209) 321-7630 <br />x*0A 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 />es