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Environmental Health Department SAN JOAQUIN <br />• <br />kw." <br />• .kv- , <br />4 <br />' <br />• <br />• <br />• <br />11.;':k•; <br /> <br />TEMPORARY FOOD VENDOR'S APPLICATION <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 ( if eeks prior to this event <br />[ t (-- 1. Name of Event: 1 Li(, <br />t <br />The following is information about my organization/business: . <br />Name of organization/business: <br />a+14--,u- -(4f -te <br /> Alt/mate: ( ) <br />List food to be sold or given to the public: <br />4. I am providing food that is NOT prepared at home: DAT/es 0 No <br />All food is prepared on-site or is from approved commercial facilities: VYes No <br />Name of facility: CoviArvi <br />, <br />Phone- ( 7--C) <br />Address of facility: 2._ f <br />I am providing a booth with the following: (to protect{ my unpackaged foid and food-preparation areas from flies, <br />dust and the public) <br />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 />Li Other (specify): <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 />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Date(s): <br />Address: <br />Phone: <br />Approved bottled water. - <br />0 On-site hose bib that is connected to a potable water source. -- <br />0 Other (specify): <br />7. Electricity is provided for my booth's use: RYes 0 No <br />tt 8. 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: El Yes El No <br /> <br />9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F. <br />Cfirrip stove <br />Electric stove top 0 Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, -- <br />.„ vegetables, potato salad, eggs, and dairy products._ <br />:14 <br />D-Dfauble steamer 11 Steam table & lids, ' <br />fl Sterno & hotel trays