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aS<kS. <br />Environmental Health Department <br />i <br />2 <br />Addicss <br />I 'hone. <br />3 <br />4 <br />| | Ollier (specify) <br />C>. <br />9. <br />tV&V <br />cooked beans, rice,meats, tamales, <br />vcMjetahles, potato salad, eggs, and dairy products. <br />7. <br />8. <br />Ih’-.H I 11 i/r-Ho!' Avenue | Slt>* I ’ m. <br />! > l< <i.' <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />signed and completed copy of this checklist to <br />Name of organizalion/busincss <br />4'2 0'g £o$-e<U\e <br />g*7g'Ll2o'? <br />SAN JOAQUIN <br />I I <br />i-.4 I)’ <b • vV*/.' ■)• 1 I'd ' <br />11 7 Nl Al i <br />the festival coordinator three (3) weeks prior Io this event <br />1.01)1 GRAPI irSIIVAI1 Name of I .vent. <br />I he following is information about my orgiinizalion/business: <br />Scxo S e^-«- S v\<A | 'Toe VAe <br />AvJvf 302/5^0.' I J; <br />(<SC^) . Ailcrnato ( ) ■ <br />I isl food to Ire sold or given Io the public . A.S.Vs . SQyN?.SA^P. / -C^-VA S Pl <br />I am providing food lhal is NOT prepared al home: I^Ycs I I No <br />All food is prepared on site or is from approved commercial facilities: IX Yes | | No <br />,, ., Phone: ( ...). - --------------Name of facility. — - - ----------- — <br />X^o^nbooth with the following: (loproleci niy pnpncK^cti iood and food-preparollon areas from Ihos. <br />dust and the public) <br />areas from lire public <br />l)ale(s) • SIPM.1/7073 <br />| lOlhei (specify):. ... . - <br />I Jcclr icily is provided for my booth s use: |XD' os I I N° <br />I am providing an accurate probe Ihermomotor In mem.'.ie <br />foods during all times of booth operation: | I Yes [ J No <br />I am providing the following hot temperature control for the I <br />13'>‘|-’ <br />| | Camp stove I | Slerno & hold Hays <br />| ’ I Joiiblo steamer iXl Steam table & lids <br />I 11 led. a; stove lop l^-Olhur (specify) <br />Note: examples of potentially hazardous food include: <br />All food vendors (both for profit and non-profit) are required to return a <br />(:.i|i|.■.ill'. 'J'-yo!' | I 'I-■■ -i. | b <br />; I Approved bottled waler. <br />Ki On-site hose bib that is connected to a potable waler source. <br />Nobr The only opornltons nol rcquinxl Io g.ovido ondosod boolhs are those., which sell bevoragos l.om <br />approved dispensers, or prepackaged foods from approved sourc.es. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />measure lhe hut and cold holding of jjotcntially hazardous <br />the hot holding of all potentially hazardous foods above