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SAN JOAQUIN �-`iviironmenial Health Depakrneni t �-!I I !•l f 1' TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of Event: L G Or Le-4- 64 1 r r.' Date(s): 2. The following is information about my organtzat:onibusiness: Name of organization/business, P Address: W t" :f� lb2,3 Phone: {�571 to Arremaie:t f_ N �a 3, List food to be sold or given to the public U r C.-e_ SA u LV } -3. I am providing fcod that is NOT prepared at home lWYes(] No J All food is prepared on-site or is from approved commercial facilities:.�?Yes❑ No Name of facility: Phone: { Lc7 , 40 12— Address of facility: 7 D/ e:K- y / 4" 5. 1 am providing a booth with the folio ving: (to protect my unpackaged food and food-preparation areas from flies dust and the public) ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other(specify): r `J<r; i♦ UJ�-1i"n C' r � �� 1 s4 r i °f�r64 z t6ry dote: The only operations not required eo p o de en6osed booths A tfiose which sell beverages from � approved dispensers, or prepackaged foods from approved sources. n. Approved water for drinking, utensil and 'nand washing will be provided in my booth by the following methods. C5cApproved bottled water. F_ On-site hose bib that is connected to a potable water source. [] Other(specify): 7. Electricity is provided for my booth's use: [) Yes N No 8. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazaraous foods during all times of booth operation: ❑Yes M No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135"F: f J Camp stove ❑ Sterno&hotel trays ❑ Double steamer ❑ Steam!able& Isds ❑ Electric stove top ® Other(specify) "V/ !' Note_ Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products, J. . _ ':_ - - ,. a «. ..•.