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SAN ) O A Q U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION ' <br /> All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three (3)weeks prior to this event. <br /> 1. 1.Name of Event. � i f � IV r VAU it • Date(s):' <br /> 2. The following is information about my organization/business, � I �1 � � I2wp <br /> Name of organization/business: <br /> Address- 21;-S- L l!r ! <br /> Phone: f.:;'�r�/ ) �1 c..'�i� ' Alternate:( ) <br /> 3. List food to be sold or given to the public: D/V J."'Sl ,•d i,l A f„ L , <br /> 4. 1 am providing food that is hM prepared at home:❑Yes No <br /> All food is prepared on-site or is from approved commercial facilities:❑Yes XNb <br /> Name of facility: _ _ Phone: <br /> Address of facility: <br /> 5. 1 am providing a booth with the following:(to protect i ny unpackaged food and fond-preparation areaq from flies, <br /> dust and the public) <br /> E I A booth with walls and telling 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 frorn the public. ��JJ <br /> ❑Other(specify): f'%/ — <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages front <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. Wg0'a z e <br /> i that is ca ectad to a potable water source. <br /> ❑On-site hose bib a <br /> ❑ Other(specify): W///� <br /> 7. Electricity is provided for my ooth's use:❑Yew MNO <br /> e. 1 am providing an accurate probe thermometer o peasure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes KNO <br /> g. 1 am providing the following hot temperature contra for the hot holding of all potentially hazardous foods above <br /> 135`F: <br /> ❑ camp stove ❑ Sterno&hotel trays J <br /> ❑ Double steamer ❑ Steam table&lids / <br /> ❑ Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice. <br /> vegetables, potato salad, eggs,and dairy products. <br /> • IKW)8 E ti,awulton Avurtuu 151tx*lort. C aiktUfnld :1: z ll;.)i T ?Ou 466-34201 IF 2U'u 4tA-0138 I ww-v% bl:.0id a.um <br /> EHU 16.02 Pepe 70111 TEMP EVENT APP <br /> n711I 7 <br />