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11 Department <br /> SANJOAQUIN <br /> k.;l;a�aili�p1i�in�:�lit X11 !I air�� A <br /> —COUNTY — <br /> �'.it,._,.:~t Grzotricss gro�rt heie. <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 _L-0 dl t Date(s , <br /> 2. The following is information about myp organization/business: <br /> Name of orgart%zation/bus€ness: a Lw� (-,!A,)n c� p <br /> i <br /> Address E V h r (Jia �ri1 <br /> Phone: {�� � ���� Alternate;{ } <br /> 3. Cistfood to be sold or given to the public; C�kMLY� ��5�� Cir 2 S <br /> 4. 1 am providing food that is NOT prepared at home:❑Yes I0 No <br /> All food is prepared on-site or is from approved commercial facilities:[A Yes El No <br /> Name of facility: - UF0 Phone:f-4o�i <br /> Address of facii€ty:�l:5 t ?' Jam. Y�I CAS �!L'. -- <br /> 5. 1 am prov€ding a booth with the following: (to protect my unpackaged fioo and food-preparation areas from flies, <br /> dust and the public) <br /> ❑ 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, <br /> from the publicand smooth wood are acceptable) and constructed to separate food and food preparation f y : <br /> fit. ,i«: a yr ,max <br /> 1 : a: W <br /> [ Other(specify): N A- -mere, l r1.) t)r L' u,'C� Noe` <br /> r _- , <br /> Dote: The eniy operations not required to provide enclosed booths are those which sell beverages from . <br /> approved dispensers,or prepackaged foods from approved sources. n ' <br /> i' <br /> 6. /approved water for drinking, utensil and hand washing will be provided in my booth bythe following methods- <br /> Approved <br /> ethods: <br /> pK �• .�:'� <br /> A sroved bottled water. ' ¢ <br /> ❑ Orr situ hose bib that is connected to a potable water source. <br /> �Other(spedify): <br /> 7. FfecIncity is provided for my hnoth's use: D.YfA V No <br /> B. I ani providing an accurato prone thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of hooth operation, ( ] YesNo <br /> m <br /> 9. 1 aproviding the following trot tempernti coi7froi lar the hot Bolding of all potentially.hazardous foods above <br /> ❑Camp stove ❑ Sterno &hotel trays <br /> []Double,steamer ❑Stoam table &lids <br /> El <br /> Flecitic stove fop ❑ Other(cpec3fy) <br /> Noto: EXarnples of potentially Izazarciorrs food lrtcltrrle: meals, talmiles, cooked hears, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> 1868 F. Hazelton AVanue 6tockt❑rt, California 96266;� .T 209 466-3420 I F 200 ACA-01313 wvwwv,,Juohd.cont <br /> UK)M 02 pap.7 of 11 7EKW FVtL f APP <br /> 0712/1 7 <br />