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Environmental Health Department <br />SAN JOAQUIN <br />COUNTY —Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />SL’i0’ <br />I <br />7. <br />8. <br />...f TEMPORARY FOOD VENDOR’S APPLICATION <br />the festlvaTc^nM^? f?r Proflt <br />1. <br />'HuniiiM <br />'nnation about my organization/business: <br />organization/business: <br /> <br />rj <br />^7) 7^7- <br /> Other (specify):--------------------------------------------------------------------------------------------------—--------------------- <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br />S On-site hose bib that is connected to a potable water source. <br /> <br />hoi and xW » of p—y h— <br />i a^roX9 SXX— hot hoiding of all potent^ hazardous foods abo.e <br />bX stove □ Stemo & hotel trays <br />0 Double steamer stearn tab,e & llds <br />lectric stove top Other (specify) <br />OSI r 20946W120I F XldUJnM I <br />Page 7^11 <br />ai^^ <br />--•'al coordinator three^S)^^kOn'PrO^ttT’e recilJlred to retum a s,9ned and completed copy of this checklist to <br />016 °f EVent: Date(s).^ey- 5" <br />The fo,,owlng is infoi <br />Name of <br />Address: <br />Phone: } _2^L^^L____________ Alternate: ^3-^70 <br />List food to be sold or given to the public: <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: S Yes No <br />Name of facility: Phone: 7^7 '^^^'*/- <br />Address of facility: 77^7^ 7 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />^(1 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 cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.