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SAN JOAQUIN <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />..... Datcus,' .' Nirne o‘ Even',1 <br />‘ / / •; 7 (r-Aefcress <br />Alternate •'Phone <br />3 <br />4 <br />, Other (specify) <br />6 Approved water lor dnnXing. vlersil and hard washing will be orovaed n my boom oy the following memoos <br />I Approved bottled watc' <br />. j On-s-te hose Irb that is connected to a potacie water soiree <br />i7.J7Zx-^___. <br />moats, tamales, cooked beans.rice. <br />(. > i* - .I <br />I'.lQt ‘■i 7 ■. . t. <br />>' 7 ?« <br />Noto: The only operabons net requrec to orovde enc.osec oooths are those v.h.pn sc. coverages 'rom <br />aeproved d socnscrs or prepackaged fooos from approved sources <br />. ’ Sterno A hclei fays <br />' J Stoat" table & lids <br />[J Other (speci'yt <br />Noto: t-xamplos of potentially hazardous food includo: <br />vegetables, potato salad, eggs, and dairy products. <br />A'l ‘cod vendors moth for p’ofit ano non-profit) are requ.ren to return a s g-cc and comp eted copy of this creckhst to <br />the 'estival coo'cmato' tn'ee (3) weeks p' or to tins evert <br />am provicing food that is NOT prepared a: home [", Yes N \c <br />A 'cod s p'epared cn-site or s from approved corrtnerciai facr1 ties . Yes.No <br />Name of facility _i ..2j. ___- ' ‘‘Phono ( '■.} <br />Address of facil ty <br />i am providing a booth with the following (to p'otcct my unpackaged food ano food-preparat on areas 'rom Ties <br />oust and the public) <br />I Other (speci'y) „_//rM P—JJj.j't____... Jn. ... J. ■. C . <br />bicctricity is provided for my booth s use ...■vos.>No ' <br />\ am providing an accurate probe thermometer to measure tne not am: cold nod.ng of ootent'alty ’>azardous <br />foods during all times of booth operation [ ] Yes Nc <br />5 <br />A beet- with wal.'s and ce ling constructed of ether wood canvas plastic s m ar material and fric mesh ‘iy <br />serpen ng. completely enclosing ocer fooc a'eas t wil also rave a smooth and cieanse c fKxr (corc'ete <br />asphalt, clean tarps anc smooth wood are acceptaoe; and const'uctec to separate 'oca and 'oed p'cparat on <br />areas from the pub ic <br />l <br />c <br />1 foods during all times of booth operation Yes <br />£' am providing tnc following hot temperature control 'or the not hold nc cf al: potentially ha/ardo. s foods above <br />135T <br />] Camp stove <br />. I Double steamer <br />; Electric Stove top <br />I.he foiicwmg i$ information about my orgarrzat on.nus ncss <br />Name of o'ganizaticn'pjsiness <br />1 ' __2/._....S U.. <br />1st food to be sold or g ven to (no puol c . >> y. /