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Ew5ronm®maa Hgafflu Department <br />2. <br />3. <br />4. <br />5. <br />6. <br />i <br />meats, tamales, cooked beans,rice, <br />7. <br />8. <br />9. <br />SAN JOAQUIN <br />COUNTY <br />signed and completed copy of this checklist to <br />■ W AS" . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festi^lcoorflrator threeweeksprinr 2Sad *“reium 3 sisned ar^ com?feted copy of this checklist to <br />1. t.feme of Event; <br />The following is information ebout my organization/business: <br /> <br /> <br />s>PC tfo <br />--------- Alternate: ( <br />Name of organization/business: <br />Address: <br />Ph°ne: ^-^^323^ Alternate; ( ) <br />List food to be sold or given to the public; ArVr/^. <br />I aijn providing food that is NOT prepared at hom'K Ioffes □No <br />All food is preparedon-site or is from approved commercial facilities: BVes No <br /> Name offecmty: Phoned? t <br />JtodXrataat^liw^ <br />p,astic' ™terial -d«"« fly <br />X^'Te'X^ Sm0°lh W”d - ’“W "XSe “foX^ <br /> Other (specify):. • • <br />’ approved dfepensera, or p^acSjed ZdXm aXyedT^Cs '*#!l’ se" b6vera9=3 from <br />Approved water for drinking, utensil and hand washing wffl bs provided in my booth by the Mowing methods: <br />E^proved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> 0ther (specify): _ x <br />Electricity Is provlde?for my booth’s use: EfYes n.No— ------ ---------------------------—----- ---------------------- <br />foods during all times Jborthb43erafion-r®^neNoUre *he G°Id h°Idin9 of P°tentiaI1y hazardous <br />E^arnp stove S^temo & hotel trays <br />Spoublesteamer Q steam tablB & Ms <br /> pectrio stove top Other (specify) <br />N0*e: vmKS °f .p,oteni,ially' hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />S2 'aZS'“™e| S“’ Ca"famia B52°4l^°s~0 I F ^46«138 , www.ejgov.org,ehd <br />TEMP EVENT APP