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SAN JOAQUIN Environ ental Health Department <br /> C OIJ f-1 T Y-- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to return a signet)and completed copy of this theddsst to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 7. ?.Name of Event <br /> f]ate(s): <br /> 2. The following is information about my organization/business' <br /> Name of organj-, i onlbusiness: <br /> Address: ) <br /> Phone: 1 ) - Alternate:( } <br /> 3. list food to be sold or given to the public: 2 <br /> a_ 1 am providing food that is NOT prepared at home: es U}No <br /> All food is r -! <br /> P o}sit or is from approved commercial fazZLoes: Yes No <br /> )Mane offacTity. Pf�one:LL <br /> Address of faciTty <br /> b, 1 am providing a booth with the fo]owing(to prot�my unpadsaged food and food-preparation areas from flies, <br /> dust and the public} <br /> A booth with walls and ceirrng constructed of either wood,canvas,Iplastic,similar material and fine mesh fly <br /> erring, compJeiefy enclosing open food areas_ it will also have a smooth and dearrable floor (concrete, <br /> asphak dean tarps and smooch wood are acceptable)and constructed to separate food and food preparation <br /> areas from the pubric <br /> n Omer(specify): <br /> Note. The only operations not required to provide enciosed booths are these which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinking,utensil and'nand washing will be provided in my booth by the f0il0r?M9 methods: <br /> Approved bctt;ed vrLr_ <br /> ❑On-site hose bib that is connected to a poiab;e water source. <br /> ❑other(specity): <br /> ?. l 1ec>ridty is provided for my booth's use: Yes❑No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot a�d cold holding of potenGalfy hazardous <br /> foods during ail times of booth operation:�es 0 No <br /> 'l35'F:lam providing the following hot temperature Gflntral for the taot holding of all potentially hazardous foods above <br /> 9. E]Camp stove 0 Stemo&hotei;rays <br /> ❑Double steamer LJ Steam table 8 lids <br /> ❑Electric stove top AOther(specify) ;� 4 L n <br /> Note_ Examples of Ge- 1( �L b� <br /> p potentially hazardous food incEu� m 'its, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E-H-2zehon Avenue( 5toddon,California 952D5 I T 2fl9 468-342fl j 1 2t)9 464-0138 1 unavr_sjcehd_ram <br /> ZM 1s-az <br /> G7!'J77 Page 7 0[37 <br /> TEtd?EVErrr App <br />