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SAN JOAQUIN <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> 3"a Catjl.-t:j to rLtu.-n a BI-jr'ej and come!ted c,:py of P-5 <br /> �3) PHOF',0 this event. <br /> Lit'. Alz5i <br /> _WAL_ x fake, <br /> 1-'17 r-g in i­-- ^n Photit my orcianzalkon7ro;,ICSS <br /> Cjrd\A&i <br /> Address- Lantoij - <br /> Phone. <br /> Lis,food,.o be sold or given to the puolic nz?C kw,or, <br /> 4 1 an providing food zhall is NOT prepared a'noire.❑Yes L�t No <br /> All food is pre-Dared on-site or is frorn approved commercial facilities. Yes 0 No <br /> Name of facoty. Phone:LV -QLI 374�f _ <br /> LL2 <br /> Add7eSS Of faaVily. xtu5k,LL, na&&4a_La J2_6>7 <br /> 3. I am p-cvidira a booth v.,ith flie (to protect my unpackaged iced and food-nreparatic-,areas`rein <br /> dust and the public) <br /> ❑f,booth:rah was and ceiling constructed of either wood,canvas,plastic,sim0arrrizltccral Sr-d f r-e lr->Sh fly <br /> screejring, completely enclosing open food areas. it will also have a smooth and ciesnab!_ floor (concrwe. <br /> asphalt, clean tarps and smooth wood are acceptable)and constructed to separate food and food pr-E!pa,—.t'on <br /> 2f-3zs from Lhir public. <br /> —I Other(specify). <br /> mote. ne only operations not required to provide enclosed booths are those v.-InIch sell Leverages iron^ <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved'.eater fc.,drinring,utensil and hand washing will be provided in my booth by the following memcds, <br /> j7 Approved boVleoli.a-eler <br /> On-site hcise bib 1hal is connected to a potable wate. source- <br /> 0 other(specify). <br /> 7. Electricity is provided for my booth's use Yes I r Yes.V-fl No za fdous <br /> f aill .5 o%jidirig an accurate probe thermometer to measure the hot and cold holding of pot�nz;ally hD <br /> foods Curing all times of booth operation:El Yes El No <br /> S. f a,n providing the following hot temperature control for the hot holding of all potentially hazardous foods abo. <br /> 13ST: <br /> LJ camp Slove ❑Sterno&hotel trays <br /> Doable steamer ❑Steam table&lids <br /> Sectrt stove top [-j Other(spec4.t <br /> Hoir.: Examples Of potentially hazardous food include: meats• tamales, cooked bearis, rice, <br /> VE:g0tailles,potato salad,eggs,and dairy products. <br /> I iiazeilon Avenue I SIOCH011, California 952051 T 209 r168.34201 F 209 464-013B I w%vvi sj:ohd.cciim <br /> N:I 7(t I I <br />