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SAN JOAQUIN <br /> <br />— r U N v- <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 (3) weeks prior to this event. <br />1. Name of Event: a 11 e,3 L tc-. I,' Date(s): 1 I I If <br />The following is information about my organization/business: <br />f <br />Address: t t '5 • i yevei j <br />Phone: ( el") ) 9 q9 31S L Alternate:( <br />List food to be sold or given to the public: pt, iciff ,t nkc. cold_ <br />I am providing food that is NOT prepared at home: E Yes E No <br />All food is prepared on-site or is from approved commercial facilities: El Yes E No <br />Name of facility: I Hub (40 Phone: (7.At-fl ) Cik)C, - Lt. r <br />A cddress of facility: t --tr.AciAt.i7Y) St- 1\4 30 r), ( se ,4) j <br />f <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 />it 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 />E 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />E Approved bottled water. <br />E] On-site hose bib that is connected to a potable water source. <br />['Other (specify): <br />Electricity is provided for my booth's use: 10 Yes E No <br />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: E Yes E No <br />9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />E Camp stove E Sterno & hotel trays <br />111 Double steamer E Steam table & lids <br /> <br />Electric stove top 2 Other (specify) -Mg yincs <br />Name of organization/business: <br />L qc <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.