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SAN JOANIN Environmental Health Department <br /> —COUNTY— <br /> TEMPOMR,Y FOOD VENDORS APPLICATION <br /> All food vendors(both for profit and non-profs are required to reh.An a and completed Y of this chedtlr;f to <br /> the festival coordinator three(3)weeks pfor to this event ed <br /> 7. 1.11arne of Event <br /> 2. The following"s inforrrsation about MY organi7a onlbusiness: <br /> Name of organizabonlbusiness <br /> Address: <br /> ox <br /> Phone Ahem I e:( ) <br /> 3. List food to be sold or given to the public: <br /> CL <br /> 4. 1 am providing food that is NOT prepared at home: es No � u t e s <br /> An food is prepared orrs�d��O �vu <br /> is from approved conanercial facTities: j Yes No <br /> Name offecxTrty. Phone: <br /> Address of facS}ity, - <br /> �. tam providerg a booth whit the f �,,ck.-d f�pd end too <br /> dust and the public)) food-preparation areas from flies, <br /> XA booth with wabs and ceifrng constructed of either wood,canvas,plask sirmlar material and fine mesh fly <br /> ing, completely enclosing open food areas It will asp have smooth and deartahle floor(concrete, <br /> asphalt,dean tarps and srrtnoth urood are acceptable)and construct to separate food and food r <br /> areas from the public. � p eparaban <br /> L]other(specify): <br /> :Note: The only operations not required to provide enclosed boot}I are those which sal) beverages from <br /> appr—ed dispensers,or prepackaged foods from approved SOL MeS. <br /> 8, Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> kApproved bottled water. <br /> ❑On-site hose bib that is connecters to a potable water source. <br /> ❑Other{specify): <br /> 7. Electricity is provided for my booth's use: Yes❑No <br /> 8. 1 am providing an acarrate probe thermorrteter In measure the hot a d cold holding of potentially hazardous <br /> foods during all times of booth operation_IR'Yes❑NO <br /> 9. 1 am providmg the following hat temperature cOrrtrol for the hot holding of all potenfiagy hazardous foods above <br /> 135"F: <br /> 0 Camp stove r]Sterno&hotel trays <br /> ❑Double steamer Steam table 8 Fds i <br /> ❑Electric stove top Ac"er(specify) t�j t a <br /> Note Examples of pATerttyally hazardors food incluZ m C Gt4� <br /> vegetables,potato salad,e99 dairy s,and slat products- � tamales, cooked beans, rica, <br /> 1'868 E.Hazelton Avenue J 5tocidon,Cafrk�mia 952051 T 2094S8r3420;' I 2094£4-0138 I www.sjcehdxom <br /> t&-W 1Sdj <br /> 07lJr7 Aeys 7 d 77 <br /> TEidp EVbvr 11Pp <br />