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f. <br />SAN JOAOUIN <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors inoth ; <br />the festival coordtnator <br />j 11,11 :010 ii..j <br />1 I Name of E‘. c <br /> Gal)e..6 h A Say 19 62 If <br />2 inc followngi, iiitirr, :LOU( riv <br />Narne Of organ,zation,bus,nes, .`.7, c. TA (1/1-.el <br />Adoress 3 3/ 0 44-A) t HO, <br />Phone. i. - 6 ty j ii k'nJ <br />3 List food fobe sold o- given to hie p,i();,:. C141.11: Po‘ot, At') L-t70 7-'1/ <br />4 I am providing food that is NOT nrepared at borne IT yes I" j Nii <br />All food is pronarcd on.sito or is ff appiovel rAllralerC!3ifaCIMICS: VYC3 El No <br />Name of facity °u64 C'JC1-3-11- r Phone k ,.65 - / <br />Address of facdity: 3 310 24 Cy -1/ 0 44 ( <br />I am providing a booth or me follow no to protect my utioacKaged food and foco-preparatio- areas from flies <br />oust and the public) <br />0 A booth witn walls and celing constructed of either wood. canvas. piastiz. s 711!5, matei.al and tile mesa fl; <br />screening, completely enclosing open food areas It wit also have a smocth ann cleanable Icor (concrete <br />asphalt, clean tarps and smootn wood are acceptable) and constructed to separate food and food preoara:ion <br />areas from the pubic <br /> <br />0 Other (specify): <br />Note: The only operations not required to provide enclosed booths are tnnse v,hten will beveragos f•cm. <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be pro:id ed in rny booth by the follow iry,: methods <br />0 Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br /> <br />D Other (specify): <br />Electricity is provided for my booth's use: ['Yes 0 No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially nazaruous <br />foods during all times of booth operation: 0 Yes 0 No <br />I am providing the following hot temperature control for the hot holoing of all potentially hazardous foods above <br />136"F: <br />D Camp stove 0 Sterno & hotel trays <br /> <br />O Double steamer Steam table& lids <br /> <br />D 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 />s,0