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SA N !QA*1 N Environrt-te _al Health Department C C)U N i Y t <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:— . oAcca \/1q j Date(s): (p I l!J <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: �'j�►�1�1 <br /> Address: <br /> Phone: �% jq Alternate: ( ) <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home: F✓j Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: 2'Yes ❑ No <br /> Name of facility.. Phone: 12(oCj <br /> Address offacility: (p2 <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food 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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> Other(specify): M Ff—_ <br /> Note: 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 /> i Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br /> Approved bottled water. <br /> [� Qn-site hose bib that is connected to a potable water source. <br /> er th (specify): <br /> s <br /> 7 ec�clty is provided for my booth's use: 0 Yes El No <br /> r� (sViding an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> �vjm, f+ '`►h�tg all times of booth operation: VYes ❑ No <br /> the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> � ❑ Sterno & hotel trays <br /> r Q tf . ❑ Steam table & lids <br /> , r,tn'"�x <br /> �3 ' f f .:' 210ther (specify) U�I'1ti�o S <br /> a� ��`11 , <br /> entially hazardous food include: meats, tamales, cooked beans, rice <br /> lad, eggs, and dairy products. <br /> 1888 E ��Maatan 'u 'u > <br /> rHo ,s-oz T � �lffornia 95205 T 209 468-3420 1= 209 464-0135 www.sjgov.orglehd <br /> " sm �t�� Page 7 of 11 <br /> TENAP EVENT 1, <br />