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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of Event <br />2 <br />Phare <br />6 my tooth by the follo Ainq methods <br />Approved bottled water <br />Lj On-site hose bib that is connected to a potable water source <br />9 <br />meats, tamales, cooked beans, rice, <br />1EMPEVENTAFf <br />8 <br /> Other (specify)____________________________________ ___ <br />Electncity is provided for my booth s use Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding ot potentially hazardous <br /> Sterno & hotel trays <br /> Steam table & lids <br />0 Other (specify) <br />Approved water fo' drinking utensil and hand washing will be provided in <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />t: Hazelton A enue i Stoc.l.lon Culifonna 9 2C:> | T 209 46b-342v| I 4 0’| <br />EHD I6-C2 Page7ottI <br />06.'1^’9 <br /> <br />j vtyiO'-'m (both for profit and ncn-profil} are required to return a signed and completed copy of thic chcckl st to <br />foods dunng all times of booth operation Yes Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F <br />I I Camp stove <br /> Double steamer <br /> Electee stove top <br />A booth with walls and ceiling constructed of either wood, canvas plastic similar matenal and f ne mesh fly <br />s reentng completely enclosing open food areas It w II also have a smooth and cleanable floor (concre’e <br />asphalt dean tarps and smooth wood are acceptable) ana constructed to separate food and food {/vpva:••>r <br />areas from the public <br />/x Other speedy) \ <br />Note The only operations not required Io provide enclosed booths are those which sell beverages from <br />approved dispensers or prepackaged foods from approved sources <br />^il ,;X3d vendors (both for profit and non-profitj c... ■ ■ ■ ■ • ■ <br />. te festival coordinator three i’3) weeks prior to this event <br />MCV) Vi\ HOL-A o i <br />■■ he fotk'v.ing is nformation about mv organization business <br />lame of orgamzation.'business <br />Add.ess <br /> Alternate ( ~ <br />2 st food to be sold or given to the public 1)0dT)U£S <br />I o'” :'ov ding food that is NOT prepareo at home Yes fj No <br />Au is pnapared on-site or is from approved commercial facil lies es [ J No <br />\ame o' facility t Phone l^c - 7 <br />."hMs of loon, A'Si B>_Aaq_V -AtayMae, t> , Z.KCUt<sS^ <br />a--- p-oviding a booth with the following (to protect my unpackaged food and food preparation areas from flies <br />dust and the public)