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Environmental Health Department <br />I d H' 4 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date/sj 1 <br />2 <br />Aootss <br />-7g68----Phone <br />3 <br />I <br />5 <br /> Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided tn my booth by the foi'owing methods6 <br />[J Approved bottled water <br /> On-s<te hose bib that is connected to a potable waler source <br />9 <br />meats, tamales, cooked beans, rice, <br />7 <br />8 <br />Note: The only operations not required to provide enclosed booths are those when sen beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />135 F <br /> Camp stove <br />Double steamer <br />O Electric stove top <br />Alternate ( ^1 <br />^^€500. S <br />SAN JOAQUIN <br />CGUN1v <br />|3 A booth w:tn wails and ceiling constructed of either wood, canvas plastc. simitar matena! and fine mesh fly <br />screening competely enclosing open food areas It will also have a smooth and cyanate floor (concrete <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food ana food preparat on <br />areas from the public <br />Noto; Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />AH focxj vendors (both for profit and non profit) aic required to return a signed and completed copy of this checkfist to <br />the festival coord*nator three (3) weeks prior to this event <br />1 Name of Event e>V\ Date/5) <br />Tne following is information about my orgamzation/busmess <br />Name of organtzabon/busmess W<K <br />__st_ ______ <br />List food to be sold or given to the public <br />I am providing food that is NOT prepared at home O Yes 0 No <br />All food is p-epared on-srte or is from approved commercial facilities Q 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-preparabon areas from flies, <br />oust and the pubic) <br /> Other (specify) ---------------------------- ------------------------------------------------------------------------- ------------- <br />Electricity is provided for my booth's use [_j Yes (XI No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentia-'ly hazardous <br />foods during all times of booth operation fl Yes O No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />D Slemo & hotel trays <br />fl Steam table & lids <br /> Other (specify)