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Environmental Health Department <br />Ii.1. Name of Event: <br />2 <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specKy): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />O Stemo & hotel trays <br />.ffisteam table & lids <br /> Other (specify) <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 />7. <br />8 sr to measure the hot astd cold holding of potentially hazardous <br /> No <br />SAN JOAOUIN <br />-----COUNTY----- <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />AU 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 /> On-site hose bib that is connected to a potable water source. <br />M Other (specify): -,> ■ ~ <br />'Electricity is provided for my booth’s use^0 Yes N< <br />I am providing an accurate probe ‘ <br />foods during ail times of booth operation: <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> camp stove <br /> Double steamer <br />Q aectric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Date(s): .JlMQ. <br />The following is information about my organizatlon/business: <br />Name of organization/business; pCC f ___ <br />yy'Vti- ___________________________ <br />- 0^ 34 Alternate: (22^ ) 2 I ^91 <br />List food to be sold or given to the public: chidcirx j pak ,-tn'tip > UfxycK ■ wWa <br />! am providing food that is NOT prepared at home:^’Yes No <br />All food is prepared on-site or is from approved commercial facilities:"^Yes O No <br />Name of facility: __ _______________________ Phone: ( ) <br />Address of facility: <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 />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.