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I iHqrmjHU’IHHl l lOr'lW’ I ilH.'.’i 1/ <br />TEMPORARY l-OOD VENDOR’S APPLICATION <br />I N • >v uf I ven!1. <br />Addicss' <br />Phone <br />3 <br />•I <br />5. <br /> <br />6 <br />9. <br />meats, tamales, cooked beans, lice, <br />vegetables, potato salad, eggs, and dally pioducts. <br />7. <br />8. <br />SAN IIIADHIN <br />v t )i Jh| I V <br />OaMs) 3'., VWP <br />[ 3 Approved bottled waler. <br /> On-site hose bib that is connected to a potable water source. <br />| J Other (specify). __________________________________ <br />Note: The only operations not required Io provide enclosed booths <br />approved dispensers, or prepackaged foods from approved sour; <br />Approved waler for drinking, utensil and hand washing will he provided in my booth by the following methods <br /> Ollier (specify):--------------------------- ——---------------------------------------------------------------- <br />U^npiovidM thermometer Io measure the hot and cold holding of potentially hazardous <br />I am providing IhVfXwhg hoi hokl.ng of all potentially hazardous foods alrove <br />135*F’| (Camp stove (J Sterno & hotel trays <br />(7I Double steamer U Steam table <3. lids <br /> bleclrrc stove lop | J Other (specify) <br />Note: Examples of polenlially hazardous food include: <br />" ; are those which sell beverages from <br />sources. <br />Alt food vcndoib (both foi piofil and non-profit) ore required hr return a signed anrl r.omplelr^d copy of Ih ’. cn '-I .! to <br />the li .sliv.il < ooidinalnr thice (3) weeks piioi to this event <br />LMi I'Aiu^ W£_^teL@K- <br />The following is information about my oiganiznlion/ljusiness <br />Non.oolor^^ess _ / <br />|lp'24 fmino N i_________________________ <br />(65^ 1 .ZOO' Alternate: ( )----- ---------------------------- <br /> <br />List food to be sold or given to the public (-------------------------------------------------- <br />I am providing food that Is NOT prepared al home Yes 1^,1 No <br />All food is piepared on-site or is from approved commercial facilities Yes I I No <br />Name of facility 0 pll0"c: < <br />Address of facility.. IIpMUivAho Cu,_------------------------------------------------------ <br />I am providing a booth with the following- (to piolect my unfrackaged food and food-preparation areas from flies <br />dust and the public) <br />Fl A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matonal and bne mesh fly <br />screening, completely enclosing open food areas It will also have a smooth and cloanable floor (conciete. <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food ano tend preparation <br />areas from the public. <br />180lil HollonAvonuoI SiocKlon.C.-.liromiaSSZOJI T 2M.>C8.3«0| F 209404.0138 | www.sjcohdxom , <br />I II I 11. 0/ <br /><m..n/