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5 <br />i <br />meats, tamales, <br />of potentially <br />SAN JOAQUIN <br />G <br />Environmental Health Department <br />•- <br />CGO'.W* <br />1 <br />signed and completed copy of this checklist to <br />W\kK^/ Date(s): 70 <br />■ae.; s, rice, <br />1 \ <br />ru <br />Note: The only operations not required to provide enclosed booths are those which sell beverages fiom <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for dnnk.ng, utens.l and hand washing will be provided in my booth by the following methods: <br />r~] Approved bottled water. <br /> On-site hose bib that is connected to a potable water source <br /> <br />I am providing an.accurate .probe thermon-ief' <br />*« &during M«mes a MW»,LJ <br />gcu» probe thermwriei. ' •' <r„. r .r ■ W •>' r» " ■ <br />, ... . m ' ■ <br />n Sterno & hotel •’a,s <br /> Carnp.we Q s,e„ aM. s' <br />: ) <br />; Ifnhl <br />c OU NT Y------ <br />'eatneiK cjrowi |1)rr(? <br />A|| food TEMPORARY FOOD VENDOR’S APPLICATION <br />xr,o re,urn a <br />Name of Event: 1^ <br />Sp1 Bowing is information about my organization/business: <br />Name of organization/business <br />-Address. <br />'hone <br />__ <br />v Vv*aAU <br /> Alternate: ( <br />Mra food to be sold or given to the public ArCy s, ' c <br />I am providing food that is NOT prepared at home 0 Yes No <br />■Ml food is prepared on-site or is from approved commercial facilities F7! Yes 0 No <br />Name of facility \ K? Ycke V>Phone: <br />Address of facility 0 ^'7 | CA , S <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 />BUSH <br />0 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. <br /> Other (specify) ------------------------------------------------------------------------ <br />Note: The only operations not required to provide enclosed booths