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TEMPORARY FOOD VENDOR’S APPLICATION <br />iaily hazardous foodsnJ? <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HEALTHDEPARTMENT <br />1868 Etrt Hszdfon Aveane, Stoclctofi, California 95205 <br />(209)468-3420 <br />Date(s): <br />[ ] Electric stove top <br />[ ] Oflwr (specify): <br />ialfy hazardous food include: meats, tamales, cooked beans, rice v^etables. <br />4. I am providing food foat is NOT prepared at home: <br />AU food is prepared on-site or is from approved cc <br />Name of facility: <br />Address of fecilitv: A~ X <br />Phone: 3.0^ Alternate: f <br />3. List food to be sold or given to foe public: <br />All food .vendor (both for profit and non-profit) are required to reton a signed and completed copy of this <br />chsckW'to foe festival coordinster three (3) weeks prior to this event <br />1. Name of Event ■ <br />2. The following is infonnatiai about my orgamzation/business: <br />Name of ormcnizatian/business: <br />Address: <br />Phone: £0? 7^? - <br />[oqYes [ ]No <br />srcial facilities: (4 Yes [ ]No <br />Phone: 72 y— <br />________________ _______ _________________________________> ___________ <br />5. I am providing a booth with the following: (to protect my unpackaged food and food-preparaticMi areas from <br />flies, dust and foe public) <br />(4 A booth wife walk and ceffii^gcanstnwted cf^ifoer wood, canvas, plastic, similar material and fine <br />mtifo fly screening, completely endosing open food areas. It will also have a smooth and cleanable floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from foe public. <br />[ ] Other (specify):• ____________________________________ <br />Note:The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispenses, or prepadcaged foods from approved sources. <br />6. Approved water for drinking, utensil and hand washing will be provided in my booth by foe following <br />- methods: <br />M Approved bottled water. <br />pd On-site how bib that is connected to apotable water somce. <br />[] Ofoer (specify): <br />7. Electricity is provided for my booth’s use: f <br />8. I am providing an accurate probe thermometer to <br />foods during ail time of booth operation: [>KYes <br />9. I am providing foe following hot fenperature control for the hot holding of all pot <br />above 135 degrees Fahrenheit: <br />Camp Stove [^Double steamer <br />[ ] Sterna & hotel trays [ ] Steam table & lids <br />Note: Examples of pc <br />potato salad, sggs and dairy products. <br />]Yes []No <br />Measure foe hot and cold holding of potentially hazardous <br />[ ] No