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..-C 0 U N 7 Y-- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All flood vendors(both for profit and non•-pn*)am required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event. iJ J1 hOt 0 '-Vfia� F Date(s). <br /> 2. The following is infomaatlon about my org 11 donAmAdness, <br /> Name of organizationlisusiness: �'���rar•• y U y V>r <br /> Address: t)-A 1w o r,,.,r, <br /> Phone: ( �bU ) - -_t�a� sa Alternate:( ) <br /> 3_ List food to be sold or given to the public: <br /> 4. 1 am providing food that is NQT prepared at home:O-Yes❑No <br /> All food is prepared onsite or is from approved commercial facilities:[✓ Yes❑No <br /> €`lame of fait={. r_ ; �_ _ R ; <br /> Address of faa7i[y �.;c? -= _ =a" r• <br /> 8. 1 am providling a booth with the fallowing:(to protect my uripacicaged food and fbod-preparation areas from fkr.. <br /> dust aW tl3e public) <br /> ❑A booth with wags and ce!WQ constructed of either wood,canvas,plastic, similar material and fine mesh fly <br /> screening, completely enclosing open food areas. It wW also have a smooth and cleanable floor(concrete, <br /> asphalt,dear`tarps and smooth wood are acceptable)and constructed to separate food and food preparation <br /> areas from the public. <br /> I <br /> ❑Other(specify): <br /> Note: The only operations riot required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources- <br /> ?�l 6, Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that Is connected to a potable water source. <br /> ❑Other(specify): <br /> ") 7. Electricity Is provided for my booth's use:El Yes❑No <br /> y , 8. f am providing an accurate probe ftrermometer to Measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation❑Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> IWF: <br /> ❑tamp stove ❑Sterno&hotel frays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove top ❑Other(specify) <br /> Note: Examples of gotentlally twzardous food bwAude. meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products.. <br /> 1866 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 j J 209 464-0138 1 v A vj.sjaov.orglehd <br /> END 16-42 Page 7 of 11 TEMP EVENT APP <br /> OBl19119 <br /> i <br />