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SAN JOAQUIN ! HviroiitiK.'iit.’l ! lo.'dih * • i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Dalc(s)1 Name of l ivcnt1 <br />2 <br />Address <br />Alternate (Phono <br />3.I.ist food to be sold or given to the public <br />4 <br />5 <br />6.Approved waler for drinking, utensil and hand washing will be provided in my booth by the following methods <br />I | Approved bottled water. <br />9 <br />meats, tamales, cooked beans, rice, <br />.b, ,|;,4 ' J <br />/Z <br />/ <br />« <br />' I Sterno & hotel trays <br />[ | Steam table & lids <br />I | Other (specify) <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 cleanablc floor (concrete <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br />)4 Ollier (specify) MgS <br />Noto: The only operations not required to provide enclosed booths are those which sell beverages horn <br />approved dispensers, or prepackaged foods from approved sources. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 throe (3) weeks prior to this event <br />h)b) &?££ <br />I he following is information about my organization/business: <br />I am providing food that is NOT prepared at iiome^^Yes ! J No <br />All food is prepared on-site or is from approved commercial facilities: ( | Yes ( | No <br />Name of facility. ___________________________ ________ ________Phone: ( ) <br />Address of facility: <br />I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />I On-site hose bib that is connected to a potable water source. <br />Yj Other (specify):. 5ZdCT <br />Electricity is provided for my booth's usezX^ Yes I I No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of optonlially hazardous <br />foods during all times of booth operation [ | Yes [ | No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />■ I35”,:; . // <br />I Camp stove ' | Sterno & hotel trays /F <br />I Double steamer <br />I I leclric stove top <br />Name of organization/business: <br />( 947- -5W <br />•( Ml‘ I V! m Al'P <br />. I I AveiHit'' ShxrkhH' C.iiil'vnia <)'. ();> | ?mi | <br />I hi; •go? I'.«](•/u ’ i <br />DAOl'PCZ-t