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SAN JOAQUIN <br /> <br />Environmental Health Department <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. 1. Name of Event: Date(s): 6 2_(1 <br />The following is information about my organization/business: <br />Name of organization/business: )f I n 1-n (4-; nn <br />Address: \(' C\ 5 a IA rA0T, Vol I \\I C %oily, <br />3 <br />Phone: ( )0 ) ;- 8 g 3 Alternate: ( <br />List food to be sold or given to the public: r \An 0501 rmtrjr )ckS< ; fr StIci A <br />- <br />I am providing food that is NOT prepared at home: R'Yes E No <br />All food is prepared on-site or is from approved commercial facilities: 2/1es E No <br />Name of facility: I S'ir\VAt.\‘‘ 30,n(4-i on Phone: ( ) <br />Address of facility:q 0 at\ (K orn \j. t111 TVA, <br />I am providing a booth with the following: (to protect my unpackaged foA 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 />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 />R'proved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />Other (specify): <br />Electricity is provided for my booth's use: C2-'Yes No <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: El Yes LI No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Camp stove LII Sterno & hotel trays <br />Double steamer l'team table & lids <br />SZtlectric stove top LI-ether (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.