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SAN JOAQUIN l:nviroriiriG‘rit;il ! lealth Dopaitnioiii <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 <br />2. <br />Phone <br />3. <br />4 <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6. <br />[ | Approved bottled water <br />9 <br />7. <br />8 <br />[’1 Sterno & hotel trays <br />EJ Steam table & lids <br />L] Other (specify) <br />□ Other (specify):------------------------------------------------------------------------------------------------------------------------------ <br />Noto: 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 />v.v.w •ijijov i-’ui <br />Tt-MP l VINT APP <br />Allernate <br /> _________________ <br />[ n A booth with walls and ceiling conslructcd 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. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1368 I I Aveiuh1 ' Stackinn ('..ilifonita| T ?09 4G8 3-12O 1 I- 20r'464 (»I t.S <br />(HO 16 0? Page/Ct 11 <br />OZ/01/2024 <br />Date(s): <br />meats, tamales, cooked beans, rice, <br />(J On-site hose bib that is connected to a potable water source. <br />CtKother (specify): IH W K- <br />Electricity is provided for my booth's use: LI Yes I I No 1 <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation, [xl Yes El No <br />I am providing the following hot temperaturd control for the hot holding of all potentially hazardous foods above <br />135°F: <br />[ ] Camp stove <br />[ ] Double steamer <br />El Electric stove (op <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of (his checklist to <br />the festival coordinator three (3) weeks prior Io this event. <br />1. Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business:. <br />Address: <br />(7^ <br />List food to be sold or given to the public: * <br />I am providing food that is NOT prepared at home: H Yes No <br />All food is prepared on-site or is frpm approved commercial facilities: [yfYes [ I 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-preparation areas from flies, <br />dust and the public)