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SAN JOAQUIN rnvironniontal Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />..l)ate(s):. .04/2.6/25 .1 <br />2 <br />Phone:( <br />3 <br />A <br />5 <br />6 <br />9. <br />meats, tamales, cooked beans, rice, <br />I | 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 />7 <br />8 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />(‘'/Approved bottled water <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 />[ ) Sterno & hotel trays <br />[ ] afeam table & lids <br />(x/other (specify) Warmer <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I ) On-site hose bib that is connected Io a potable water source <br />[ | Other (specify)________________________ _ <br />Electricity is provided for my booth's use:S/ Ycsyt I No <br />I am providing an accurate probe lhermomete/lo measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation |\1acs | I 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 />| | Double steamer <br />[ ) Electric stove top <br />I!}'..;1, I I la/olloii Avenue I Slocklon. California‘)5205 | T 209'168 3420 | I- 209 464 0133 | www sjgov oig.'ehd <br />f HOU,07 PagnroMl II.W’F.VINr AT’P <br />06/19'"9 <br />).„_ 510-932-9707 Alternate: ( ) _916.-705-4900 <br />l ist food to be sold or given to the public. F£6Sh CUt fflGS, Chicken WiflCJS/tendGrS, SOft ... <br />/ drinks and lemonade <br />I am providing food that is NOT prepared al home: [ Smes [ J No , <br />All food is prepared on-site or is from approved commercial facilities Hl Yes ( I No <br />Name of facility Valet.Storage p,ionc: (J..916-4.98.-9787 <br />Address of facility., n 00 Richards Blvd,..Sacramento,. CA 95811-------------------- <br />I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, <br />dupt and the public) <br />.V 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 />1. Name of Event. ._J_Odi BeefFest <br />The following is information about my organization/busincss: <br />Name of organization/busincss: Fresh Fries Frenzy <br />Address 7204 Elvora Way, Elk Grove, CA 95757