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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): April 14th-17thI.Name of Event:1. <br />The following is information about my organization/business:2. <br />Midway of Fun <br />Address: <br />) Alternate: ((916 ) (916)803-4651Phone: <br />Please see attached menuList food to be sold or given to the public:3. <br />4. <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 /> Approved bottled water. <br />[3 On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: [x] Yes No7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />7/14/15 <br />Name of organization/business: <br />9700 Fair Oaks Blvd, Suite J, Fair Oaks CA 95268 <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: Please see attached menu <br /> Camp stove Stemo & hotel trays <br />O Double steamer Q Steam table & lids <br /> Electric stove top Other (specify) <br />Al! 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 />San Joaquin Asparagus Festival <br />S A 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 />I am providing food that is NOT prepared at home: Q Yes No <br />All food is prepared on-site or is from approved commercial facilities: Lxl Yes O No <br />Name of facility: on-site Phone: (1 <br />Address of facility:__ ________________________________ <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: S Yes No