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Environmental Health Department All food vendors (both for profit and non-profit) are required to return DS) Date(s): 1. 2. Address: 3. 4 5. 6. 9. meats, tamales, cooked beans, rice. 7. 8. Other (specify):--------------------- ------------------- -------------------—------- only operations not required to provide enclosed booths SAN JOAOUIN COUNTY - TEMPORARY FOOD VENDOR’S APPLICATION a signed and completed copy of this checklist to 1868 E. Hazeton Avenue | SWUon. CaMornia 952051 T 209 468-34201 F 209 464-0138 | wwwX9OvWehd 11 ....<-_________ _ Note- The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. Other (specify): ____—------------------------------------------------------------ --------------------------- Electricity is provided for my booth's use: UfYes L) No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation; Yes No I am provKi.og the following hot temperature control for the hot holding of all potentially hazardous foods above Camp stove H'Sterno & hotel trays Double steamer Steam table & lids O Electric stove top Other (specify) Noto: Examples of potentially hazardous food Include: vagatables, potato salad, eggs, and dairy products. the festival coordinator three (3) weeks prior to this event. p O £__^Qt-1 2^7-^I.Name of Event: The following is information about my organization/business: Name of organization/business: CTS-------— 3,31 p H TTlli------------------- Phone (2-01 ) 2-tn ^Ig,Alternate: (4^ )-644 ------------- LISI food .o be soid or given to (he public: I am providing food that is NOT prepared at home: Yes O No All food is prepared on-site or is from approved commercial facilities: 0Yes No Name of facility; Phone. ---------------- Address of facility ^3)0 H UN 0 ---------------------------- pmv.ding a booth with the following: (to protecT^^^ areas from fl,es' dust and the public) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar materral anc screemng. completely enclosing open food areas. It wtll also have a smooth and cleanable ftaJconcrete^ asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food prepa a. . areas from the public.