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AN JOA UIN COUNTY <br /> ENVIORMENTAL HEAL'TRDEPARTM ENT <br /> ,v• . 180 East Bxzekm Amne,Stoddoa,Caffornia"20 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendm(ice for profit and non-profit)we tequire:d to return a signed and completed copy of this <br /> &cklis&the festival coordwastor throe(3)weeks prior to this oveaL <br /> 1. Name of Event: Z ✓ ZLw,,r Dato(s): <br /> 2. Ile following is ' ormetion about my orpnizad : <br /> Name of onihnine": <br /> Address: F6 d t /66 <br /> Phone: 6 �- _ Alternate: S - V 4 -m <br /> 3. List food to be sold or gim to the public: W� <br /> 4. 1 am providing food that is NOT pre;arod at home: [UQ Yes f ]No <br /> All food is prepared on-site or is$om approvpd.oonwwmW facilities: [AYes [ ]No <br /> Name of fawility: Phone: e-�j 7 Z _ <br /> Address of&Wlity:_ ,1' <br /> S. 1 am providing a booth with the following: (to protect my u apWa aged food and food-parepanttion amen from <br /> flies,most and ft a public) <br /> [AA booth wM-wWh-and ceil�©onmucted of either woad,canvas,Plastic,similar material and fine <br /> mob fly scrcmw& completely enclosing open food areas. It will also have a mnooth and ckanW*floor <br /> (concrete,malt,clean tarps and smooth wood are aomp+table)and corusmwcted to wpa3ratc food and food <br /> preparation arras f m the public. <br /> [ j other(spay*): <br /> Now The only opesudow not regwred to provide oaclosed-booths are thaw which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for dnnkin&utensil and hand washing will be provided in my booth by the following <br /> methods: <br /> Approved battled water. <br /> Or-aitc bow brb#bar is conned to a potable water sowrce. <br /> [ ] Other(qxoify): <br /> 7. Electricity is provided for my booth's use: 1<1 Yes [ ]No <br /> 8. 1 am providing an accurate probe dxmnometer W&mmire the hot and cold holding of potentially hazardous <br /> foods during all time of booth op wrti : [ es F f No <br /> 9, 1 an providing the following but teempeMWfC control for the hot holding of all potentially hawdous foods <br /> above 135 degrees Fahrenheit: <br /> Camp Stove ["10 steamer [ ]Electric stove top <br /> [ ] Sterna&hotel trays [ ] Steam table&lids [ ) Otha(specify): <br /> NoW Exasmpks of potadally huwdotus food include:meats,tamales,cooked beams,rice vegemble s, <br /> potato salad, eggs and dairy products. <br />