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Environmental Health Department <br />Date(s): <br />2. <br />C ca.IZ^ x, 4- dcn<s’s <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />SAN JOAQUIN <br />COUN“v <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordhSor^ree^^ek^^ even?6 t0 3 S'9ned and comp,eted ^PV of this checklist to <br />1. <br />E-"'””"*”1 I -..I,....®- <br />TEMP EVENT APP <br />1. Name of Event: LeUt t <br />The following is information about my organization/business: <br />Name of organization/business: P,va4A,v VW. ■ -Gv.V, <br />Address: CtOrpTAK T^-ln Pr-ttzAf-Mj TfA- q^iHI___________ <br />Phone: (^OA ) ------------------------Alternate: (6 '7) <br />List food to be sold or given to the public: PfACLV. D <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: H-Yes No <br />Name of facility: __-A- f=t »f. p phone: ( > <br />Address of facility: 1 ---------------------------------------------------------------------------------- <br />' Za guy"1 fOl'°Wi^ (to nnpackaged food and food-prepatabon areas from flies,' <br />s^relntgXte"^^^^^^ P^c, similar material and fine mesh fly <br />KXX8"4 s™°" to <br />0 Other (specify); c-ncc^S Lc>n traiUx <br />~ ™ .«■ <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />□^Approved bottled water. <br />EJOn-site hose bib that is connected to a potable water source. <br /> Other (specify): ____ <br />Electricity is provided for my booth’s use: STYes No -------------------- ------------------------— <br />foods during all tim^of btw^peraton-^Ye?oImo^6 hOt C°ld holding °f Potential|y hazardous <br />I am providing the following hot temperature control for the hot holding of all potenfially hazardous foods above <br /> Camp stove q Stemo & hotel trays <br /> Double steamer Q steam tab|e & |jds <br /> Electncstovetop 0 Other (specify) <br />vegetables, P0ta°^saXflX^d7aiXducte.de: "“'S’ ,:"T’=lGS’ cookcd bean®> dee,