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SAN JOAQUIN I nvi rr>i it hoi H;> I I Ic.'ilih I h'p.iriii ici -i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Dalc(s)1 Name of I:vent1 <br />2 <br />Address: <br />Phone <br />3. <br />4 <br />5 <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />[ | Approved bottled water <br />[ | On-site hose bib that is connected to a potable water source <br />9 <br />meats, tamales, cooked beans, rice, <br />• in .im : <br />7. <br />8 <br />A.'. .7 J(l’, i"'d <br />l| M”l VI Nt API’ <br />| | A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood arc acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Other (specify) <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />h'h'. l I Avi'iiiii' ■ C ililonn.i( I ?il<.i 'IG.': 1 I <br />I HO 10 OZ P.-kic / of 11 <br />0//OVZ07-1 <br />[ | Other (specify):_____________ <br />Electricity is provided for my booth's use | | Yes IVTNo <br />I am providing an accurate probe Ihermomete^to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation |Vi Yes ( ) No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />! | Camp stove <br />M Double steamer <br />! | Electric stove top <br />The following is information about my organization/business <br />Name of orgamzation/business.. T-'-( <br />AT-oH c:\Y- CW <br />( Q _ Alternate ( .^33' '-^3 3 <br />l.ist food to be sold or given to the public C -Vv S, cVc. cALQvk *•, <br />I am providing food that is NOT prepared at home. Ms/es [ ] No <br />All food is prepared on-site or is from approved commercial facilities. lXYcs t I No <br />Name of facility X Phone: 'AX9^- <br />Address of facility:.. \\t)jZ)__;gVm.vV.Xs... __CtA Q S Lt <br />I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />| | Sterno & hotel trays <br />[ | Steam table & lids <br />ItTOthei (specify) A l'