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Environmental Health Department <br />1. <br />2. <br />) Phone: <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />8 <br />SANdOAQUIN <br />; ------COUNTY------ <br />GreoJness jroirs htffe. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> <br />The following is information about my organization/business: <br />Name of organization/business: —CXbAfA —-------------------------- - <br />AddreK: __UxA C^- <br />(£01 -___________ /Jtemste: ( <br />List food to be sold or given to the piihllr.:'P\. )V^.zX f TCT’1'.----------_ <br />I am providing food that is NOT prepared at home: j^pYes Q No <br />All food is prepared on-site or is from approved commercial facilities:'^:¥es No <br /> <br /> Name of fadlity:....__Phone:i---------------------------------------------------------------------------------------- <br />l^i^aSing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies. ’ <br />dust and the public) <br />Fl A booth with wails and ceiling constructed of either wood, canvas, plastic, similar matenal and fine mesh J1* <br />Greening completely enclosing open food areas. It will also have a smooth and clean able floor fcOTcrete. <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparaton <br />areas from the public. <br />pother (specify): ------- <br />Note: The only operations not required to provide enclosed boothst are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing wiD be provided in my booth by the following methods: <br />J^-Approved bottled water. <br />0On^ite hose bib that is connected to a potable water source. <br />O Other (specify):_ _—--------—-------------------------------------------------— ~ <br />the hot and ootd hotdins of potent hazardous <br />, hotdtng ofatl potency hazardous foods above <br />o Camp stove Stemo & hotel trays <br />O Double steamer Steam table & lids <br />O Electric stove top Other (specify) <br />jT Mote: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.